Ayres Chloe, Burbidge Hanna, Garratt Jayna, Mohan Ganendra Raj, Leung Yee, Jeffares Stephanie, Bilic Sanela, Cohen Paul A
Western Australian Gynaecologic Cancer Service, Department of Obstetrics and Gynaecology, Women and Newborn Health Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
Department of Nutrition and Dietetics, Women and Newborn Health Service, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
Cancer Rep (Hoboken). 2025 Apr;8(4):e70172. doi: 10.1002/cnr2.70172.
Pre-operative very low calorie diets (VLCDs) can achieve rapid and safe weight loss, yet no studies have evaluated VLCDs in the severely obese endometrial cancer population prior to surgery. Our aim was to evaluate the safety and feasibility of a 4-6 week pre-operative nutritional intervention with the Optifast VLCD prior to surgery in patients with clinical stage 1, Grade 1 endometrioid endometrial adenocarcinoma and a body mass index ≥ 35 kg/m.
This was an investigator-initiated single-arm prospective observational study. Co-primary endpoints were safety and feasibility. Secondary endpoints were changes in anthropometric measures, blood pressure, biochemistry, perioperative complications, length of stay and final tumour stage. Tolerability and compliance of the VLCD were assessed by fortnightly questionnaires and urinary ketones.
Twenty-eight patients were enrolled, of which 25 underwent the intervention. 22/25 patients (88%) completed at least 4 weeks of Optifast. Mean (SD) age was 56.4 (6.3) years, and mean body mass index (BMI) was 45.2 (7.1) kg/m. Significant decreases in weight (mean 8.2 kg [3.6]), BMI (mean 3.1 kg/m [1.3]), waist and hip circumference (mean 5.7 [6.5] and 4.5 cm [4.1], respectively), and diastolic blood pressure (10 mmHg [14.1]) were observed (p < 0.001 for all). One patient had a flare of gout. All patients had laparoscopic surgery without adverse events. Optifast was considered acceptable, and compliance was 40% to 61.9%. Eighty-eight percent (22/25) of patients had FIGO 2009 Stage 1A Grade 1 endometrioid endometrial adenocarcinoma on final staging.
A 4-6 week pre-operative VLCD in severely obese clinically low-risk endometrial cancer patients appears safe, feasible and well tolerated.
术前极低热量饮食（VLCD）可实现快速且安全的体重减轻，但尚无研究评估过在严重肥胖的子宫内膜癌患者术前采用 VLCD 的情况。我们的目的是评估在临床分期为 1 期、1 级的子宫内膜样腺癌且体重指数≥35kg/m²的患者术前使用 Optifast VLCD 进行 4 - 6 周营养干预的安全性和可行性。
这是一项由研究者发起的单臂前瞻性观察性研究。共同主要终点是安全性和可行性。次要终点包括人体测量指标、血压、生化指标、围手术期并发症、住院时间和最终肿瘤分期的变化。通过每两周一次的问卷和尿酮评估 VLCD 的耐受性和依从性。
28 名患者入组，其中 25 名接受了干预。22/25 名患者（88%）完成了至少 4 周的 Optifast。平均（标准差）年龄为 56.4（6.3）岁，平均体重指数（BMI）为 45.2（7.1）kg/m²。观察到体重（平均减轻 8.2kg [3.6]）、BMI（平均降低 3.1kg/m² [1.3]）、腰围和臀围（分别平均减少 5.7 [6.5] 和 4.5cm [4.1]）以及舒张压（降低 10mmHg [14.1]）均有显著下降（所有 p < 0.001）。1 名患者痛风发作。所有患者均接受了腹腔镜手术且无不良事件。Optifast 被认为是可接受的，依从性为 40%至 61.9%。88%（22/25）的患者在最终分期时为国际妇产科联盟（FIGO）2009 年 1A 期 1 级子宫内膜样腺癌。
在严重肥胖的临床低风险子宫内膜癌患者中进行 4 - 6 周的术前 VLCD 似乎是安全、可行且耐受性良好的。
