Daijiworld Media Network - London
London, Aug 18: Helping women lose weight in the weeks before surgery for endometrial cancer could reduce the risk of postoperative complications, according to a UK feasibility study.
The study found that a short, intensive weight-loss programme delivered between diagnosis and surgery was achievable for most patients and was associated with fewer complications following surgery.
Endometrial cancer is the most common gynaecological cancer in high-income countries and is more strongly associated with obesity than almost any other cancer. Excess weight can also increase the risk of complications following surgery, which is the main treatment for many patients.
Researchers from nine hospitals across England recruited 78 women with a body mass index (BMI) of 28 kg/m² or higher who were awaiting curative surgery for endometrial cancer. Participants were randomly assigned either routine care or a dietitian-supported weight-loss programme.
Those in the intervention group replaced their normal food entirely with nutritionally complete meal-replacement products, providing about 800 calories and 76 grams of protein per day. They also received regular telephone support from a dietitian.
As surgery for endometrial cancer generally cannot be postponed for long, participants followed the programme for a median of only 28 days before their operation. This was considerably shorter than the intervention periods used in similar preoperative weight-loss studies involving other cancers.
Despite the limited timeframe, women following the intensive programme lost an average of 5.3 kg before surgery, which was 3.5 kg more than those receiving routine care. Nearly half of the women in the intervention group, or 44%, achieved a clinically meaningful weight loss of at least 5%, compared with only 12% in the routine-care group.
The researchers also observed fewer postoperative complications among women who followed the programme. Within 30 days of surgery, 27% of women in the intervention group experienced a complication, compared with 51% among those receiving routine care.
The difference was mainly due to a reduction in moderate, grade II complications, which generally require medical treatment such as antibiotics or blood transfusions.
No serious adverse events were attributed to the diet. Quality-of-life measures, as well as anxiety and depression scores, remained similar between the two groups throughout the study.
Researchers also found no evidence that the rapid weight loss resulted in a significant loss of fat-free mass. Muscle and other lean tissue were largely preserved, addressing concerns that very low-calorie diets could cause muscle loss, particularly among older people and patients preparing for major surgery.
Engagement with the programme was high, with 85% of participants attending their scheduled calls with dietitians. Most women who followed the diet also reported positive experiences with the programme.
The researchers said the findings support the feasibility of conducting a larger trial to determine more conclusively whether preoperative weight loss can improve surgical outcomes for women with endometrial cancer.
The proportion of participants achieving at least 5% weight loss, however, fell slightly below the study's original target. Researchers suggested that future programmes could be adapted to help more participants achieve the desired level of weight reduction.
They also said introducing the intervention earlier in the diagnostic pathway could provide women with more time to lose weight before surgery and potentially increase the number reaching the 5% target.
Overall, the study indicates that even a short period of structured, dietitian-supported weight loss before endometrial cancer surgery may be practical and potentially beneficial, while preserving lean tissue and without compromising patients' quality of life.