We read an article written by Jernigan et al with interest. The authors performed a survey study in obese women with complex atypical hyperplasia or early-stage endometrial cancer regarding medical or surgical referral to bariatric specialist. They found that only 17 in 100 women complied with medical or surgical referral. The authors recommended that obese endometrial cancer survivors should be offered weight loss options early in the course of cancer. However, they did not mention whether medical or surgical option would be more beneficial in this population. In this letter, we want to emphasize the importance of bariatric surgery in women who have high risk of endometrial cancer.

In a metaanalysis, bariatric surgery has benefits in significantly reducing the risk of endometrial cancer compared with medical management. In a case report, bariatric surgery in obese women with early-stage endometrial cancer was more beneficial than conventional weight loss. It served as an adjuvant therapy in fertility-preserving treatment of endometrial cancer with local progestin. The cancer-protective effects of bariatric surgery are thought to be due to a decreased level of estradiol, insulin resistance, and inflammation.

In conclusion, gynecologist should strongly consider surgical weight loss as a therapeutic option in suitable endometrial cancer candidates. More clinical studies should be done to assess benefit and risk of bariatric surgery in this population.