Endometriosis Linked to Higher Postoperative Risks in Stage I Endometrial Cancer Surgery

Patients with endometriosis undergoing surgery for stage I endometrial cancer face higher risks of serious postoperative complications, including septic shock and venous thromboembolism, according to a large national study. Researchers presented their results at the Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer in Seattle, WA.

The study used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2016 to 2022. Researchers identified 27,183 women older than 18 years of age diagnosed with stage I endometrial cancer who underwent surgical management. Of these, 1533 patients, representing 5.6% of the cohort, had a pre-existing diagnosis of endometriosis. The investigators performed descriptive and multivariate analyses to determine how endometriosis affects postoperative outcomes. Variables found to be significant in univariate analysis were included in a stepwise logistic regression model, with statistical significance defined as a P value less than 0.05.

The study found that patients with endometriosis were more likely to experience longer hospital stays, longer operative times, and were more often subjected to open surgical approaches. Specifically, women with endometriosis stayed in the hospital an average of 1.52 days compared with 1.27 days for those without the condition. Surgeries lasting more than 3 hours were also more common among patients with endometriosis, occurring in 32% of cases versus 25% of those without endometriosis. In addition, 22% of patients with endometriosis underwent open surgery, compared with only 14% of women without the condition.

The presence of endometriosis was associated with a higher incidence of serious 30-day postoperative complications. After adjusting for relevant clinical variables, patients with endometriosis had more than triple the odds of developing septic shock, with an adjusted odds ratio (aOR) of 3.34 and a 95% confidence interval (CI) of 1.35 to 7.11. Patients with endometriosis were also more than twice as likely to develop venous thromboembolism requiring therapy (aOR = 2.43; 95% CI, 1.11 to 4.71). Other complications, including blood transfusions and superficial incisional infections, were also significantly more frequent in patients with endometriosis on univariate analysis.

“Given the prevalence of endometriosis, it is crucial to incorporate this condition into the preoperative optimization process for these patients,” the study authors concluded. “Further research is needed to identify specific interventions that can mitigate postoperative complications in patients with both endometriosis and early-stage endometrial cancer.”

Reference:
Elchouemi M. Postoperative complications among endometriosis patients undergoing surgical management for stage I endometrial cancer: The American College of Surgeons National Surgical Quality Improvement Program study. Paper presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Accessed March 11, 2025. https://www.sgo.org/events/annual-meeting/