SUPPORTING patients to lose weight prior to surgery for endometrial cancer could reduce post-surgery complications, a UK study finds.
The feasibility trial suggests that a short, intensive weight loss programme delivered in the weeks between diagnosis and surgery is not only achievable for most patients but may also reduce risk of post-surgery complications.
Endometrial cancer is the most common gynaecological cancer in high-income countries and is more strongly linked to obesity than almost any other cancer. Excess weight also raises the risk of complications after the surgery used to treat it.
Researchers from nine hospitals across England recruited 78 women with a BMI of 28 kg/m² or higher who were awaiting curative surgery for endometrial cancer and randomly assigned them to receive either routine care or a dietetic-supported programme.
The programme involved replacing normal food entirely with nutritionally complete meal replacement products, providing around 800 kcal and 76g of protein a day, alongside regular telephone support from a dietitian.
Because surgery for endometrial cancer typically cannot be delayed for long, participants followed the programme for a median of just 28 days before their operation, a notably tighter window than similar preoperative weight loss studies in other cancers.
Despite the short timeframe, women in the intervention group lost an average of 5.3kg before surgery, 3.5kg more than those receiving routine care. Almost half (44%) achieved a clinically meaningful weight loss of 5% or more, compared with just 12% in the routine care group.
Researchers found that just 27% of women in the intervention group experienced a postoperative complication within 30 days, compared with 51% of those receiving routine care.
This difference was driven mainly by fewer moderate (grade II) complications, the kind typically requiring medical intervention such as antibiotics or blood transfusion.
No serious adverse events were linked to the diet itself, and quality of life, anxiety, and depression scores were similar between the two groups throughout.
Crucially, researchers found no evidence that this rapid weight loss came at the expense of fat-free mass. Muscle and other lean tissue were largely preserved, addressing common concerns with very low-calorie diets, particularly in older or surgical populations where muscle loss can worsen recovery.
Levels of engagement with the programme was high, with 85% of participants attending their scheduled dietitian calls, and most who tried the diet rated it positively
As a feasibility study, it suggests that a full-scale trial could conclude more definitively whether pre-surgery weight loss programmes could lead to better outcomes for women with endometrial cancer.
The one area falling short was the proportion of participants reaching 5% weight loss, which landed just below the original goal. For this reason, researchers suggest that any future research could benefit from adaptations to enhance weight loss by participants.
Overall, authors suggest that involving women earlier in their diagnostic pathway, therefore allowing more time on the programme, could help more participants reach that threshold in future research.
Reference
Koutoukidis D et al. Intentional weight loss before endometrial cancer surgery to support postoperative recovery (ENDO-CARE): a multicentre, feasibility randomised controlled trial in England. The Lancet Obstetrics, Gynaecology, & Women’s Health, 2026
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