The feasibility of a medically supervised preoperative weight loss program in patients with obesity and atypical hyperplasia, or low-grade endometrial carcinoma

Objectives To assess the efficacy of preoperative weight loss in women with obesity and either atypical hyperplasia (AEH), or low grade endometrial carcinoma (EC), measured through weight change. Methods Prospective cohort study in women with AEH or EC, and a BMI of ≥ 40 kg/m 2 . Preoperative weight loss was medically supervised, utilizing Optifast 900® full meal replacement for 12 weeks, or a hybrid approach. Follow up was 12 months after surgery. Demographic, laboratory, pathologic, clinical, and follow up outcomes were collected. Continuous variables were summarized as mean (SD) or median [IQR] based on normality (Shapiro-Wilk test); categorical variables as frequencies and percentages. Changes in weight and BMI were analyzed using paired t -tests or Wilcoxon Signed-Rank tests accordingly. Secondary analyses were exploratory. Patient experience was explored utilizing qualitative interviews and analyzed with thematic analysis until saturation. Result 104 patients enrolled from November 2020 to January 2022. Mean age 56 (SD 10.9), and BMI 50.0 kg/m 2 (SD 7.9). 72/104 (69.2%) completed the intervention, and mean weight difference from consultation to surgery was −15.0 kg (SD 10.2, p < 0.01). Final pathology (FIGO 2009): 68/72 AEH or stage I EC, 3 stage II, 1 stage IIIC1. Mean weight difference from surgery to 8 weeks was −0.7 kg (SD 6.5, p 0.4280), and from surgery to 12 months was +3.53 kg (SD 10.5, p = 0.215). There was 1 recurrence that led to death at 2 years (stage IA, grade 1 EC, MMRd). Conclusion Preoperative weight loss appeared feasible and was associated with substantial short-term weight loss in selected patients with obesity and low risk endometrial cancer or AEH. Larger comparative studies are needed to determine perioperative benefit and oncologic safety.