The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery

Abstract

Abstract:The aim of this study was to compare the financial and clinical outcomes in roboticassisted laparoscopic surgery for primary endometrial cancer between obese and nonobese women. The hospital finance department assessed the total admission costs for robotic surgery for endometrial cancer in 54 women. This included a subanalysis for costs over nine areas (ward and clinics, drugs and pharmacy, medical staff, theaters, blood products, imaging, pathology, rehabilitation therapy, and high dependency costs). Furthermore, a prospective collection of morbidity and surgical outcome data was performed. The study group included 21 nonobese and 33 obese women (body mass index >30). Obese women were more likely to stay for more than one night in hospital (20/ ). There were six Clavien-Dindo grade II complications in the obese group and two in the nonobese group. The average overall costs were £1,852 greater (95% CI £431-£3,277, P=0.012) in the obese group. Diabetes and hypertension were associated with increased costs, but obesity was the only independent variable. In conclusion, greater resource should be allocated to obese women undergoing primary surgery for endometrial cancer.

A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis

“…Outcomes with robotic surgery improve with numbers performed so this would potentially be biasing the results in favour of the more established standard laparoscopy arm. Furthermore, some authors have acknowledged worse co‐morbidity in the robotic arms of their studies with obesity in particular associated with worse outcomes . Therefore the data in favour of robotic laparoscopy is in spite of adverse confounders.…”

Introducing robotic radical hysterectomy for stage 1bi cervical cancer—A prospective evaluation of clinical and economic outcomes in a single UK institution

“…Costs were assessed independent of clinicians by the hospital's finance department using a system called “Patient Level Inpatient Costs” (PLIC) that has been described in detail previously . In summary, costs and over‐heads were allocated into one of nine categories.…”

“…Costs" (PLIC) that has been described in detail previously. 4,6 In summary, costs and over-heads were allocated into one of nine categories.…”

Proficiency-based progression training in robot-assisted laparoscopy for endometrial cancer: peri-operative and survival outcomes from an observational cohort study

“…Robot-assisted laparoscopic (RAL) surgery was introduced in gynecological surgery in 2005 ( 4 ) and provides more precision, better views, reduced patient morbidity and improved surgeon ergonomics compared to conventional laparoscopy enabling the surgeon to perform more complex surgery ( 5 – 10 ). These advantages are especially beneficial in obese patients undergoing open or laparoscopic hysterectomy as they are more prone to post-operative morbidity compared to non-obese patients ( 11 – 13 ). Obesity is the main risk factor for endometrial cancer and since its incidence is rising ( 14 ), the preferred approach in minimally-invasive surgery has shifted from straight-stick to robotic ( 5 , 15 , 16 ).…”

“…The Society of European Robotic Gynecological Surgery and British and Irish Association of Robotic Gynecological Surgeons followed by providing training a curriculum for robot-assisted gynecological surgery ( 22 , 23 ). Previous studies have evaluated the effect of a single-surgeon learning curve on peri-operative outcomes ( 11 , 13 , 14 ). However, the general effect of PBP training on peri-operative and survival outcomes in endometrial cancer patients undergoing RAL surgery has not been evaluated.…”