Intentional Weight Loss before Endometrial Cancer Surgery to Support Postoperative Recovery: The ENDO-CARE Feasibility Randomised Controlled Trial
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Koutoukidis D.A.
Jebb S.A.
Reynolds S.
Hill T.M.
Foster C.
Baker-Rand H.
Ellis L.B.
Morrison J.
Horne A.
Peace F.
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2026
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Aims: To assess the feasibility of a preoperative weight loss intervention to reduce postoperative complications for women with endometrial cancer and excess weight. Methods: Women with BMI>=28kg/m2 awaiting curative endometrial cancer surgery at nine centres across England were randomised 1:1 to usual care or dietetic support with a low-energy (800kcal/day, 76g protein/day) total diet replacement programme between diagnosis and surgery (ISRCTN13577800). Progression criteria for a definitive trial included recruitment (>=72 patients), engagement (>=75% of dietetic phone appointments attended), adherence (>=60% of intervention participants achieving >=5% weight loss), and retention (>=85%). Secondary outcomes included blindly graded morbidity, symptoms, and changes in weight and fat-free mass. Results: Between 06/11/2023-28/02/2025, seventy-eight participants were randomised and 72 eligible participants who underwent surgery (n=37 intervention, n=35 usual care) were included in the analysis. Participants attended 85% of their dietetic appointments. The median (IQR) period from randomisation to surgery was 28 (13) days, during which 44% of intervention and 12% of usual care participants lost >=5% of their weight OR: 6.00 (95%CI: 1.75-20.59)]. Intervention participants lost 5.3kg (4.1) before surgery; 3.5 kg (95% CI: 1.8, 5.1) more than the usual care participants, with no evidence of between-group difference in fat-free mass 0.8kg (95%CI: -3.2, 1.6)]. Intervention participants experienced fewer complications than those in the routine care group 27% vs. 51%, OR: 0.35 (95% CI: 0.13, 0.93)]. There were no serious adverse events. Retention was 86%. Conclusion(s): The intervention led to meaningful weight loss and fewer postoperative complications than routine care. It appeared to be safe and participants were highly engaged. A definitive trial is warranted and could benefit from adaptations to enhance weight loss.Copyright © 2026, The Authors. All rights reserved.
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