Impact of Obesity on Surgical Approaches to Gynecologic Malignancies

Abstract

As already described in previous chapters, the obesity epidemic in America is on the rise, with approximately 36\% of Americans being obese, and more than 6\% having Class III obesity (8\% in women) defined as a BMI >= 40 kg/m(2). The rising obesity rate in women has profound effects on gynecologic malignancy occurrence and treatment. As surgery is a part of treating the majority of gynecologic malignancies, understanding the nuances of intra-operative and peri-operative management of the obese patient is an essential skill of the gynecologic oncologist. This chapter will briefly review the medical and anesthetic considerations for surgery in the obese woman with a gynecologic malignancy. It will focus on the impact of obesity in surgery in both endometrial cancer and in ovarian cancer as well as mention the impact on other gynecologic cancers. The chapter concludes with a mention of techniques that can be employed to facilitate surgery in obese women.