The Role of Bariatric Surgery in Gynecologic Oncology

Obesity is a major global health problem and a key modifiable risk factor for gynecologic malignancies, particularly endometrial cancer. Excess adipose tissue promotes carcinogenesis through hormonal dysregulation, chronic inflammation, insulin resistance, and adipokine imbalance, and increasing organ size may further expand the pool of susceptible target cells. Bariatric and metabolic surgery (MBS), mainly sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB), provide durable weight loss, metabolic improvement, and substantial reductions in obesity-related cancer risk. Observational cohorts and meta-analyses consistently demonstrate lower incidence of endometrial, ovarian, breast and colorectal cancers, as well as reduced cancer-specific and all-cause mortality after MBS. Emerging data indicate regression of endometrial hyperplasia and early endometrial carcinoma in women undergoing bariatric surgery, and pilot trials suggest the feasibility of combined gynecologic and bariatric procedures in carefully selected patients. Current American Society For Metabolic and Bariatric Surgery(ASMBS)–International Federation For The Surgery and Obesity (IFSO) guidelines broaden indications to include patients with Body Mass Indeks (BMI) ≥35 kg/m² regardless of comorbidities and those with BMI 30–34.9 kg/m² with metabolic disease; however, major oncology guidelines have not yet incorporated MBS as a standard anticancer intervention. This chapter summarizes epidemiologic, pathophysiologic and clinical evidence, highlights perioperative Enahnced Recovery After Surgery (ERAS)-based management, and outlines key research priorities including fertility preservation, pharmacokinetics of systemic therapies, procedure-specific outcomes, and integrated cancer prevention strategies.