Obesity May Increase Surgical Complications in Epithelial Ovarian Cancer

Obesity is associated with a higher risk of complications in ovarian cancer surgery, making it a potential prognostic risk factor for patients with epithelial ovarian cancer (EOC), according to a study published in BMC Surgery.¹

The researchers highlighted the rising incidence of obesity in recent years and its role as a risk factor for EOC. Therefore, obesity may significantly increase the risk of operative complications and perioperative mortality in patients with EOC undergoing surgery.²

However, the impact of obesity in this population remains unclear.¹ To address this, the researchers conducted a study to evaluate the clinical effects of obesity on operative complications and postoperative outcomes in patients with EOC.

The most common surgical complications in obese patients with epithelial ovarian cancer (EOC) include wound infection, intestinal complications, and a higher 30-day readmission rate. | Image Credit: Hunterframe - stock.adobe.com

Using related keywords, the researchers searched the MEDLINE and EMBASE databases for eligible studies published between January 1, 2006, and May 31, 2023. Two authors independently screened and assessed each study, searching the references for other potential sources they may have missed. They also independently extracted and summarized data, including the study design, total sample size, surgical procedures, and complications.

The researchers identified 1147 studies, 14 of which met the inclusion criteria, including 3 prospective cohort studies and 11 retrospective cohort studies. Three studies were performed in Asia, 4 in Europe, and 7 in the US. Also, the studies included 4858 total subjects.

Two studies evaluated obesity's impact on surgical complexity. They suggested that obesity may be linked to a low surgical complexity score (risk ratio [RR], 1.08; 95% CI, 1.01-1.15; P = .05). In contrast, no significant associations were found for moderate (RR, 0.9; 95% CI, 0.79-1.02; P = .05) or high (RR, 0.77; 95% CI, 0.55-1.08; P = .05) surgical complexity scores.

Also, 3 studies examined the association between obesity and surgical complication severity. Two studies found no significant correlation, while one suggested that obesity may increase the risk of severe complications.

Consequently, a meta-analysis of these studies suggested that obesity (RR, 0.050; 95% CI, 0.07-3.79; P = .501) may be associated with higher EOC surgical complication rates vs non-obesity (RR, 0.60; 95% CI, 0.22-1.63; P = .316). However, these results were not statistically significant.

Additionally, a meta-analysis of 8 studies indicated that obesity correlated with increased surgical complications among patients with EOC. Surgical complications included wound infection (RR, 2.71; 95% CI, 1.59-4.61), intestinal problems (RR, 2.09; 95% CI, 1.00-4.35), and a higher 30-day readmission rate (RR, 1.84; 95% CI, 1.16-2.93).

Post-surgery, obese patients with EOC had shorter prognosis-free survival than non-obese patients (standard mean difference [SMD], 0.62-year; 95% CI, 0.13-0.15). In contrast, the researchers found no significant difference in overall survival between the 2 groups (SMD, 0.01-year; 95% CI, 0.13-0.15).

Lastly, subgroup analyses of 30-day (RR, 1.03; 95% CI, 0.98-1.09), 90-day (RR, 2.69; 95% CI, 0.99-7.30), and 360-day (RR, 0.95; 95% CI, 0.77-1.18) mortality showed no significant difference in mortality rates between obese and non-obese patients with EOC.

The researchers acknowledged their study’s limitations, including that it only analyzed studies written in English; this may result in potential language bias. Considering their limitations, they suggested areas for further research.

“Due to the small sample size of studies and lack of RCTs, more studies are needed to better clarify the effect of obesity in ovarian cancer surgery and explore the possible effect of mechanisms,” the authors concluded.

References

1. Sheng J, Li C, Zhang J, Jin Z, Zhou YX, Huang Y. The effects of obesity on surgical complications and postoperative prognosis of epithelial ovarian cancer: a meta-analysis. BMC Surg. 2025;25(1):119. doi:10.1186/s12893-025-02770-7
2. Bacalbasa N, Balescu I, Dimitriu M, et al. The influence of the preoperative status on the risk of postoperative complications after cytoreductive surgery for advanced-stage ovarian cancer. In Vivo. 2020;34(2):839-844. doi:10.21873/invivo.11846