# Cardiopulmonary Complications in Obese Patients with Gynecologic Cancer: A Narrative Review

## TL;DR

Obese gynecologic cancer patients face higher cardiopulmonary risks due to obesity-related conditions and cancer treatments, requiring better preoperative and postoperative care.

## Contribution

This review highlights the unique cardiopulmonary challenges in obese gynecologic cancer patients and emphasizes the need for multidisciplinary care strategies.

## Key findings

- Obesity increases cardiopulmonary complications in gynecologic cancer patients, including heart failure and respiratory issues.
- Surgical treatments for gynecologic cancer pose significant cardiopulmonary stress, especially in obese individuals.
- Enhanced recovery pathways and preoperative risk stratification are recommended to improve outcomes in this high-risk group.

## Abstract

Gynecologic cancer is a major global health burden, and improvements in screening, surgical techniques, and systemic therapies have significantly prolonged survival. As a result, cardiopulmonary disease has emerged as a leading non-cancer cause of morbidity and mortality among gynecologic cancer survivors. Obesity, which is highly prevalent in this population, substantially increases cardiopulmonary risk by contributing to metabolic syndrome, cardiovascular disease, chronic inflammation, and reduced cardiopulmonary reserve. This narrative review summarizes current evidence on the epidemiology, pathophysiological mechanisms, and clinical spectrum of cardiopulmonary complications in obese patients with gynecologic malignancy. We review the contribution of obesity-related metabolic and endothelial dysfunction, cancer-associated hypercoagulability, and treatment-related toxicities, with particular emphasis on complications arising from surgery, chemotherapy, and radiotherapy. Epidemiologic data demonstrate a markedly increased burden of cardiovascular and pulmonary disease in obese gynecologic cancer patients, including higher rates of myocardial injury, heart failure, venous thromboembolism, and postoperative respiratory complications. Surgical treatment, although central to oncologic management, imposes substantial cardiopulmonary stress, placing obese patients at heightened perioperative risk. Future studies should focus on preoperative risk stratification, optimization of obesity-related comorbidities, and multidisciplinary perioperative management, including enhanced recovery pathways, as well as appropriate use of high-dependency or intensive care monitoring to reduce morbidity and improve both oncologic and long-term non-oncologic outcomes in this population.