# Examining the Association of Body Mass Index and Complications When Including Sentinel Lymph Node Biopsy in Minimally Invasive Surgery for Endometrial Intraepithelial Neoplasia

## TL;DR

This study found that body mass index does not increase the risk of complications in minimally invasive surgery for endometrial intraepithelial neoplasia, regardless of whether a sentinel lymph node biopsy is performed.

## Contribution

The study provides new evidence that BMI does not independently affect complication rates in this specific surgical context.

## Key findings

- BMI was not independently linked to postoperative complications in minimally invasive surgery for endometrial intraepithelial neoplasia.
- Sentinel lymph node biopsy did not increase complication rates, regardless of BMI category.
- Obese patients had similar complication rates as non-obese patients in this surgical procedure.

## Abstract

This study aimed to examine the relationship between body mass index (BMI) and postoperative complications in women who underwent minimally invasive hysterectomy for endometrial intraepithelial neoplasia, with or without sentinel lymph node biopsy. The cohort consisted of 4428 patients, with 584 undergoing sentinel lymph node biopsy. The majority (76.5%) were obese, and 41.6% had a BMI of 40 or higher. The overall complication rate was 6%, with no significant difference in complications between those with and without sentinel lymph node biopsy, regardless of BMI. The regression analysis showed that neither BMI nor sentinel lymph node biopsy was independently linked to complications. Additionally, for patients who underwent sentinel lymph node biopsy, BMI showed no association with any type of complication. This study concluded that in minimally invasive surgery for this condition, BMI does not correlate with an increased risk of postoperative complications, regardless of the procedure type.

Objective: We aimed to study the association of patient’s body mass index (BMI) with postoperative complications in patients surgically treated for endometrial intraepithelial neoplasia, with and without sentinel lymph node biopsy. Methods: A cohort study using the prospective National Surgical Quality Improvement Program database. Women with endometrial intraepithelial neoplasia on postoperative pathology who underwent minimally invasive hysterectomy from January 2012 to December 2020 were included. The cohort was dichotomized based on the performance of sentinel lymph node biopsy. We analyzed postoperative complications based on the World Health Organization (WHO) categories of BMI. Results: A total of 4428 patients met the inclusion criteria. Of those, 584 (13.2%) had sentinel lymph node biopsy. Overall, 76.5% of patients (n = 3389) were obese (BMI > 30.0), with 1840 (41.6%) patients of BMI ≥ 40.0. The rate of any complications was 6.0% (n = 264), major complications 2.3% (n = 101), and minor complications 4.2% (n = 187). When comparing the rate of any complications between patients who had sentinel lymph node biopsy vs. those without a sentinel lymph node biopsy procedure, stratified by BMI category, there was no association between sentinel lymph node biopsy performance and any complications in any of the BMI categories. In a multivariable binary regression analysis, BMI and the performance of sentinel lymph node biopsy were not independently associated with any complication [adjusted odds ratio (aORs) 1.001, 95% confidence interval (CI) (0.98–1.01), and aORs 1.1, 95% CI (0.82–1.65), respectively]. In an analysis of the cohort of patients who underwent sentinel lymph node biopsy, there was no association between the rates of any major or minor complications with BMI categories or obesity. ROC analyses for the association between BMI and occurrence of any major or minor complications had a low performance. Conclusions: In minimally invasive surgery for endometrial intraepithelial neoplasia, there is no association between body mass index and increased risk for postoperative complications when performing hysterectomy with sentinel lymph node biopsy versus hysterectomy alone.