Preoperative Weight-Loss Program Shows Feasibility Before Endometrial Cancer Surgery

A short-term, intensive weight-loss program before surgery was feasible and produced meaningful weight loss in women with endometrial cancer and excess weight in the randomized ENDO-CARE trial. The intervention was also associated with fewer postoperative complications, although the study was not designed to determine whether weight loss definitively reduces surgical complications. The findings were reported by Koutoukidis et al in The Lancet Obstetrics, Gynaecology, & Women’s Health.

Endometrial most cancers is the commonest gynecologic most cancers in high-income nations and has a very sturdy affiliation with weight problems. Weight problems additionally will increase the danger of postoperative problems, which may lengthen hospital stays and improve health-care prices.

Examine Particulars

The multicenter feasibility randomized managed trial was carried out at 9 gynecologic most cancers facilities in England. Eligible individuals had been ladies aged 18 years or older with a physique mass index of not less than 28 kg/m² who had been awaiting healing surgical procedure for endometrial most cancers.
Individuals had been randomly assigned 1:1 to routine care or a low-energy whole weight loss program substitute program with behavioral help. Girls within the intervention group had been requested to exchange all meals with 4 nutritionally full meal-replacement merchandise per day, offering about 800 kcal and 76 g of protein day by day, and obtained common phone help from a dietitian till the day earlier than surgical procedure.

The first goal was to find out whether or not a bigger definitive trial can be possible. Prespecified development standards included recruitment, attendance at dietitian calls, the proportion of intervention individuals shedding not less than 5% of physique weight, participant retention, and security. Postoperative problems, signs, weight change, and fat-free mass had been secondary outcomes.

A complete of 78 individuals had been randomly assigned, and 72 had been included within the evaluation: 37 within the intervention group and 35 within the routine-care group. The median age was 60 years, the imply physique mass index was 38.5 kg/m², and the median time from randomization to surgical procedure was 28 days.

Key Findings

Individuals attended 85% of anticipated dietitian appointments, and 86% accomplished follow-up. Sixteen ladies within the intervention group, or 44%, misplaced not less than 5% of their physique weight earlier than surgical procedure in contrast with 4 ladies, or 12%, receiving routine care.

Imply weight reduction earlier than surgical procedure was 5.3 kg with the intervention vs 1.8 kg with routine care, an adjusted between-group distinction of three.5 kg. There was no proof that the intervention led to larger lack of lean physique mass.

Postoperative problems inside 30 days after surgical procedure occurred in 27% of individuals within the intervention group vs 51% with routine care (odds ratio = 0.35), pushed primarily by fewer average postoperative problems. Nevertheless, the investigators famous that this was a feasibility trial not powered for medical efficacy and that the discovering ought to subsequently be thought of hypothesis-generating.

No severe antagonistic occasions had been reported among the many 72 individuals included within the evaluation. Preoperative antagonistic occasions had been extra widespread with the intervention, most frequently dizziness, constipation, headache, and diarrhea. Most had been grade 1 or 2.

The investigators stated the findings help testing the method in a bigger, adequately powered trial. “Our information present reassurance for each sufferers and clinicians concerning the security and feasibility of intentional weight reduction in ladies carrying extra weight as a element of prehabilitation earlier than endometrial most cancers surgical procedure,” they wrote.

Dimitrios A. Koutoukidis, PhD, of the Nuffield Division of Main Care Well being Sciences, College of Oxford, Oxford, United Kingdom, is the corresponding writer of the article.

DISCLOSURE: The research was funded by the Nationwide Institute for Well being and Care Analysis. For full disclosures of the research authors, go to thelancet.com.