Robotic Hysterectomy in Severely Obese Patients With Endometrial Cancer: A Multicenter Study

Study Objective: The aim of this study was to evaluate the surgical and oncologic outcomes of robotic hysterectomy with or without or less pelvic and aortic lymphadenectomy in severely obese patients (body mass index [BMI] ≥ 40 kg/m²) with endometrial cancer. Material and Methods: Between August 2010 and November 2014, patients with histologically confirmed endometrial cancer and BMI ≥40 kg/m² were deemed eligible for the study and underwent RH with or without pelvic and aortic lymphadenectomy. Results: Seventy patients were divided into 3 groups according to their BMI: group A, BMI between 40 and 45 kg/m² (50 patients); group B, BMI between 45 and 50 kg/m² (10 patients); and group C, BMI above 50 kg/m² (10 patients). No significant statistical differences were found between the 3 groups in terms of operation time, blood loss, hospital stay, and oncologic results. Pelvic lymphadenectomy was performed in 42%, 30%, and 20% of patients in groups A, B, and C, respectively. An intraoperative complication occurred in 1 patient in group A, early postoperative complications in 4 patients in group A and in 1 patient in group C, and a late postoperative complication occurred in 1 patient in group A. No conversions to laparotomy were necessary; however, 3 patients underwent conversions to laparoscopy in group A and 1 patient in both groups B and C. Conclusion: Our study showed that robotic surgery in severely obese patients with endometrial cancer is safe and feasible. Moreover, it seems that an increase in BMI does not change the surgical and oncologic outcomes. However, randomized controlled trials are needed to confirm these results.