Does Apronectomy Improve Outcomes for the Morbidly Obese Patient Undergoing Gynae Cancer Surgery? A Review of Four Cases

TitleDoes apronectomy improve outcomes for the morbidly obese patient undergoing gynae cancer surgery? A review of four casesAimsThe aim is to describe the short-term outcomes of performing apronectomy at the time of laparotomy for gynae malignancy in the morbidly obese patient.BackgroundFor the morbidly obese patient undergoing laparotomy and pelvic clearance in the context of an oestrogen-driven gynae cancer, concomitant apronectomy confers multiple benefits - optimising intra-operative pelvic access; improving post-operative recovery and general health; as well as also having the potential to reduce future peripheral oestrogen production, with positive implications for cancer recurrence. MethodsA retrospective case-note review of morbidly obese patients undergoing apronectomy as a component of gynae cancer surgery between 2017 and 2019 in a district general hospital in Northern Ireland was performed. ResultsFour patients were identified, with mean age 56 years and mean BMI 53kg/m2. Three patients were undergoing laparotomy for endometrial adenocarcinoma, and the fourth for suspected ovarian malignancy. At each surgery, the operating team consisted of a minimum of three Consultants: one gynae-oncologist, one gynaecologist and one plastic surgeon. No anaesthetic complications occurred. Each patient received intra-operative antibiotic prophylaxis and underwent TAH, BSO, omentectomy/omental biopsy and apronectomy with re-siting of the umbilicus. The average weight of apron excised was 9.6kg. Each patient had two negative-pressure wound drains placed. Skin was closed with monofilament sutures and negative-pressure dressings applied. No intra-operative complications occurred, the maximum blood loss was 300mls and mean operating time 217 minutes. One patient required HDU for 24hours. Immediate post-operative complications included anaemia (50%); wound infection/partial dehiscence (50%); one case of return to theatre for debridement of a non-viable umbilicus; paralytic ileus (25%); and urinary tract infection (25%). The mean length of stay was 16 days. In the 30 day post-operative period, one patient was readmitted with wound infection.ConclusionsOverall, apronectomy appears to be a safe addition to laparotomy in this challenging patient population.