Hysteroscopy and Weight Loss in Treatment of Endometrial Cancer: Case Report and Literature Review

Gallo, Alessandra;D'Alisa, Rossella;Di Spezio Sardo, Attilio;Guerra, Serena;Berardi, Giovanna;Vitale, Salvatore Giovanni

;Palumbo, Mario;Cretella, Pasquale;Angioni, Stefano;Bifulco, Giuseppe;Musella, Mario

2023-01-01

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Abstract

Fertility-sparing treatments have become important for young women with atypical endometrial hyperplasia (AEH) or endometrial carcinoma (EC) who wish to preserve their reproductive potential. Evidence indicates a strong relationship between weight and EC and the effect of weight loss on reducing the risk of EC. We report the case of a young obese woman with a body mass index (BMI) of 46.6 kg/m2, diagnosed with grade 2 endometrial endometrioid adenocarcinoma, who underwent a combined fertility-sparing treatment with hysteroscopic resection followed by insertion of a levonorgestrel intrauterine system. After twelve months of failure to achieve a complete response, bariatric surgery was proposed to lose weight and improve the response to treatment. Histologic regression was achieved three months after surgery, with a weight loss of 30 kg and fifteen months after combined treatment of endometrial cancer. We reviewed the literature to summarize the evidence on the role of bariatric surgery and weight loss in modifying the oncologic and reproductive outcomes of women undergoing fertility-sparing treatment for atypical endometrial lesions.