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.
目的：本研究旨在探讨子宫内膜上皮内瘤变手术患者（无论是否接受前哨淋巴结活检）的体重指数与术后并发症之间的关联。 方法：采用前瞻性国家外科质量改进计划数据库进行队列研究。纳入2012年1月至2020年12月期间接受微创子宫切除术且术后病理确诊为子宫内膜上皮内瘤变的女性患者。根据是否实施前哨淋巴结活检将队列分为两组。依据世界卫生组织（WHO）的体重指数分类标准，分析术后并发症发生情况。 结果：共4428例患者符合纳入标准，其中584例（13.2%）接受了前哨淋巴结活检。总体而言，76.5%的患者（n=3389）属于肥胖（BMI>30.0），其中1840例（41.6%）患者BMI≥40.0。总体并发症发生率为6.0%（n=264），主要并发症为2.3%（n=101），次要并发症为4.2%（n=187）。按BMI类别分层比较接受与未接受前哨淋巴结活检患者的总体并发症发生率，结果显示在任何BMI类别中，前哨淋巴结活检的实施与并发症发生均无显著关联。多变量二元回归分析表明，BMI和前哨淋巴结活检的实施均非并发症发生的独立影响因素[调整后比值比（aOR）分别为1.001，95%置信区间（CI）（0.98-1.01）和aOR 1.1，95% CI（0.82-1.65）]。在接受前哨淋巴结活检的患者亚组分析中，主要或次要并发症发生率与BMI类别或肥胖状态均无显著关联。BMI与主要或次要并发症发生关联的受试者工作特征曲线分析显示预测效能较低。 结论：在子宫内膜上皮内瘤变的微创手术治疗中，无论是否联合实施前哨淋巴结活检，患者体重指数均未显示与术后并发症风险增加存在关联。
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