Impact of obesity on surgical and oncologic outcomes in patients with endometrial cancer treated with a robotic approach

Abstract

AimThe surgical treatment of endometrial cancer (EC) can be more complicated in obese patients. Robotic surgery could simplify the surgical approach in these patients. The aim of our study was to compare the outcomes of robotic surgery in obese (body mass index ≥30 kg/m2) and nonobese patients.MethodsWe performed a retrospective study on patients with EC benefitting from a robotic approach in our institution. The primary outcome was the 5‐year overall survival (OS). We also assessed the 5‐year recurrence‐free survival (RFS), type of surgery, laparotomy conversion rate, adjuvant treatment and postoperative morbidity.ResultsWe analyzed 175 consecutive patients with EC who underwent robotic surgery, 42 patients with obesity and 133 patients without. The median follow‐up length was 37 months [1–120]. The OS rate was 97% in the whole population and the RFS was 74%. Obesity did not impact prognosis. Laparotomy conversion rate was low in both groups (5% in patients with obesity vs 3%, P = 0.619). There were no significant differences in terms of postoperative complications (5 vs 9%, P = 0.738). There were significantly less pelvic lymphadenectomies in patients with obesity (5 vs 12%, P = 0.005). In the subgroup of patients with high‐risk EC, rate of lymphadenectomy and of adjuvant treatments did not differ between patients with or without obesity.ConclusionObese patients with EC can be safely treated with a robotic approach, with a low complication rate and similar oncological outcomes compared to nonobese patients.

Obesity and mortality among endometrial cancer survivors: A systematic review and meta‐analysis

“…Briefly, study populations were predominantly white, over 60 years of age, diagnosed with Type I endometrial cancer and had FIGO stage I. Most of studies were conducted in Europe ( n = 20) 12,13,15,18,21,22,27,43–55 and North America ( n = 18) 19,20,23–26,56–67 . The remaining studies were conducted in Asia ( n = 4), 14,68–70 Oceania ( n = 2), 17,71 and South America ( n = 1) 72 .…”

“…The main reasons that studies were rated as low quality ( n = 13) were inappropriate ascertainment of exposure, insufficient follow‐up time, and lack of adjustments for additional variables (Table S3). Additionally, one study reported a point estimate outside the 95% CI and therefore was not included in meta‐analyses 54 …”

Obesity and Endometrial Cancer

“…Even though the patients have early-stage cancer, they may not be able to be operated on due to concomitant systemic diseases such as cardiovascular and diabetes mellitus, and they may have to undergo primary radiotherapy. Robotic surgery may provide an advantage over conventional laparoscopy in such patients [68,69].…”

The effect of steep head-down tilt on respiratory status in endometrial cancer patients with obesity during robot-assisted hysterectomy

“…We demonstrated that patients with a BMI ≥ 40 kg/m 2 had a marked increase in P means and P peaks compared with patients with a BMI < 40 kg/m 2 . Some reports state that the incidence of complications does not differ significantly between patients with and without obesity undergoing robotic surgery ( Kawai et al, 2021 ), and some suggest that the effect of a higher BMI on breathing during anesthesia is more significant than the effect of a lower head position ( Sprung et al, 2002 , Suh et al, 2010 ). In the present study, under PCV, a 5° difference in head-down tilt did not significantly affect respiratory status other than the P peak.…”