Comparison of laparoscopic and robot-assisted approaches in the surgical treatment of patients with endometrial cancer and morbid obesity. Preliminary results

Endometrial cancer ranks 2nd after cervical cancer in the structure of oncogynecological diseases worldwide and 1st in economically developed countries. Among patients with endometrial cancer, the incidence of concomitant obesity can reach 60%. Minimally invasive techniques such as laparoscopic or robot—assisted approaches are often used in the treatment of patients with endometrial cancer, especially patients with morbid obesity. Compared to traditional open surgery, these approaches can reduce the risk of complications and accelerate recovery. Objective. Comparative assessment of surgical outcomes of laparoscopic and robot-assisted panhysterectomy in combination with or without pelvic lymphadenectomy in the surgical treatment of patients with endometrial cancer and morbid obesity. Materials and methods. A one-stage comparative study was conducted with the participation of 177 endometrial cancer patients suffering from pathological obesity who underwent surgical treatment with standard and robot-assisted laparoscopic access on the basis of the GBUZ MO MONIIAG named after academician V.I. Krasnopolsky in the period from 2015 to 2024 years. Results. Based on the medical documents of individual and group records, the medical data of 374 patients diagnosed with endometrial cancer were analyzed, among them 177 (47.3%) women had morbid obesity (median body mass index — BMI 46.6 kg/m2). These patients were divided into 2 groups depending on operative access: group 1 consisted of women operated with standard laparoscopic access (n=98), group 2 (n=79) — with robot-assisted laparoscopic access. There were no statistically significant differences in the volume of blood loss, the number of lymph nodes removed, and the number of intra- and postoperative complications. There was one case of laparoconversion in the robotic access group due to bleeding in a patient with an extremely high BMI >53 kg/m2. Pelvic lymphadenectomy was performed in 22 (22.9%) patients from group 1 and 15 (19.0%) patients from group 2. The BMI of patients in group 1 who underwent lymphadenectomy was lower than in group 2 (median 40.5 and 47.9 kg/m2, respectively). Conclusion. Robot-assisted laparoscopy is safe in the treatment of patients with endometrial cancer and morbid obesity: the results obtained are comparable with the results of standard laparoscopy. Nevertheless, given the statistically significant differences in BMI in the groups of patients who underwent pelvic lymphadenectomy along with panhysterectomy, the robotic system makes it more likely to carry out full surgical treatment in conditions of pathological obesity.