Retrospective Analysis of Patients Experiencing Gynecological Cancer in Conjunction with Liver Dysfunction

Abstract

The risk of gynecological cancers is dramatically increased in the setting of obesity, which has been estimated to affect up to 50% of the population. A component of the metabolic syndrome, obesity has been associated with fatty infiltration of the liver in up to 20% of individuals, leading to steatohepatitis and overt cirrhosis in the most severe cases. With surgery being the cornerstone of treatment in the case of gynecological malignancies, it is inevitable that surgeons will encounter patients with both diseases. Given that the need for surgical intervention in these patients often conflicts with the high surgical morbidity known to exist in cirrhotics, the aim of this study was to reconcile these contradictions. After appropriate Institutional Review Board approval, patients were identified through the International Statistical Classification of Diseases and Related Health Problems version 9 codes (Table 1) by the University of Utah Health Sciences Enterprise Data warehouse team. Parameters used were types of surgical procedures used to treat the gynecological malignancies. Although a small sample size was used, its rigorous control methods strengthened the validity of the conclusions. Patients presenting with liver dysfunction exhibited a trend toward a more complicated hospital course (Table 2.1 & 2.2). This was supported by (A) higher fresh-frozen plasma usage (an average of 10.46 units higher with P<0.001), (B) a longer average hospital stay (an average of 7.69 days longer with P<0.001), and (C) an increase in post-operative complications not associated with chemo- or radiation therapy (4.58 x higher with P=0.186). From these results, we concluded that that patients harboring evidence of cirrhosis or liver disease undergoing major gynecological procedures for oncologic indications are likely to incur a set of significant complications post-operatively. Because of this, it is incumbent upon clinicians to screen for the presence of these disorders so that complications can be mitigated.