What question did this study set out to answer?

To evaluate the feasibility and safety of robotic surgery for endometrial cancer in Class III obese women.

February 24, 20260 citationsOpen Access

Robotic Surgical Outcomes in Endometrial Cancer: Does Class III Obesity Matter?

VCVito Andrea Capozzi AGA GallinelliUniversity of Parma ESElisa ScarpelliUniversity of Parma

Key Points

To evaluate the feasibility and safety of robotic surgery for endometrial cancer in Class III obese women.
Retrospective study conducted at a single center.
Women with early-stage endometrial cancer underwent robotic hysterectomy with bilateral salpingo-oophorectomy.
Patients divided into BMI groups: Class III obese (≥40 kg/m2), overweight (30-39 kg/m2), and normal/underweight (<30 kg/m2).
Compared perioperative variables such as operative time and complications across groups.
No significant increase in intraoperative (p=0.390) or postoperative (p=0.805) complications for Class III obese women.
Operative time was significantly longer in Class III obese women (p=0.003).
Successful bilateral sentinel lymph node mapping was lower in Class III obese women (73.1%) compared to overweight (95.6%) and normal/underweight (81.6%).

Abstract

Background/Objective: Women with Class III obesity (BMI ≥ 40 kg/m2) have a lifetime risk of endometrial cancer (EC) as high as 10–15%. However, evidence focused specifically on Class III obese patients remains limited. This study evaluated the surgical feasibility and safety of robotic surgery in Class III obese women with EC. Methods: A single-center retrospective study was conducted at the ESGO-accredited University Hospital of Parma (Italy) from October 2021 to February 2025. All women had apparent early-stage EC and underwent robotic hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node (SLN) mapping with Indocyanine Green. Patients were categorized into three BMI groups: Group A (BMI ≥ 40 kg/m2), Group B (BMI 30–39 kg/m2), and Group C (BMI < 30 kg/m2). Perioperative variables—including operative time, estimated blood loss, conversion to laparotomy, intra- and postoperative complications, hospital and Intensive Care Unit (ICU) stay, and SLN mapping failure—were compared across groups. Results: A total of 109 women were included: 26 (23.9%) in Group A, 45 (41.3%) in Group B, and 38 (34.9%) in Group C. Class III obesity was not associated with higher intraoperative (p = 0.390) or postoperative (p = 0.805) complication rates. Conversion to laparotomy (p = 0.720), estimated blood loss (p = 0.123), ICU stay (p = 0.156), and hospital stay (p = 0.491) were superimposable across groups. Operative time was significantly longer in Group A (p = 0.003) compared to the other groups. Successful bilateral SLN mapping differed significantly across groups (p = 0.026), being lower in Group A (73.1%) compared to Group B (95.6%) and Group C (81.6%). Conclusions: Robotic surgery is safe and feasible in Class III obese EC patients, with perioperative morbidity comparable to that of lower BMI groups. Nevertheless, longer operative times and a lower rate of successful bilateral SLN mapping highlight the need for tailored strategies and further research to optimize nodal staging in severely obese women.

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