Risk factors for postoperative complications following hysterectomy in endometrial cancer patients: A systematic review

Background: Endometrial cancer is the most prevalent type of cancer of the female reproductive system. Certain risk factors have been linked to a range of severe postoperative complications following hysterectomies in this patient population. Therefore, this systematic review aims to encompass all the significant risk factors identified that lead to postoperative complications in endometrial cancer patients following hysterectomy and possible risk factor mitigation strategies that can be made to limit these postoperative complications. Methods: The authors conducted the search across four libraries, including Cochrane, VHL, Web of Science, and PubMed. The authors identified original studies published from inception till November 2, 2024, that were relevant to the research question and fit the eligibility criteria. Results: Preoperative factors include cancer staging, diabetes, frailty, obesity, medications, ASA class, and smoking; while intraoperative considerations include blood loss, operative time, length of hospital stay, lymphadenectomy, and surgical complexity. These risk factors were found to lead to a variety of postoperative complications ranging in grades on the Clavien Dindo classification (CD), including surgical site infections, urinary tract infections, lymphedema, lymphorrhea, lymphocyst, wound disruption, wound dehiscence, respiratory issues, ileus, and prolonged hospital stays. Conclusion: Before undergoing hysterectomies, endometrial cancer patients should be screened for risk factors to decrease the risk of postoperative complications. The employment of tailored mitigation strategies for individual patients through preoperative optimization, intraoperative management, and patient counseling is essential in preventing postoperative complications. By improving patient care and reducing hospital-acquired costs, surgeons will be more equipped to handle complex procedures and prevent unwanted outcomes.