A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma

ObjectiveMinimally invasive surgery offers advantages for management of obese patients, but technical difficulty often deters its utilization. Compared to laparotomy, robotic surgery should allow comparable staging and improved surgical outcomes. Therefore, we evaluated outcomes in robotic and laparotomy cohorts of obese women with endometrial cancer at our institution.MethodsRetrospective robotic and laparotomy cohorts of obese women (BMI ≥ 30 kg/m2) undergoing surgical management of primary endometrial cancer from March 2006 to March 2009 were formulated utilizing a computerized database. Patient demographics, operative statistics, peri-operative complications, and pathologic details were collected in an intent to treat analysis. Chi-square or Fisher's exact test and t-test were used for statistical analysis.Results73 women underwent robotic surgical management, 11% converted to laparotomy. Mean BMI (39.8 vs. 41.9, p = 0.152), number of co-morbidities (2.49 vs. 2.62, p = 0.690), number of previous surgeries (0.97 vs. 0.94, p = 0.841), and lymphadenectomies performed (65.8% vs. 56.7%, p = 0.227) were similar between cohorts. Total lymph nodes obtained were not statistically different between cohorts (8.01 vs. 7.24, p = 0.505). Total operative time and room time was significantly longer for robotic surgery; however, estimated blood loss, the percentage of patients receiving transfusion, hospital length of stay, wound complications (4.1% vs. 20.2%, p = 0.002) and other complications (9.6% vs. 29.8%, p = 0.001) were improved for the robotic cohort.ConclusionsRobotic management of obese women with endometrial cancer yields acceptable staging results and improved surgical outcomes. Although operating time is longer, hospital time is shorter. Robotic surgery may be an ideal approach for these patients.

Research highlights
► Robotic surgical staging is feasible in obese women with endometrial cancer.
► Surgical outcomes are improved with the use of robotics versus traditional laparotomy in this obese cohort with endometrial cancer.
► Operating time may be longer—representing a learning curve—but length of hospital stay is significantly shorter with minimally invasive robotic staging.