Sentinel lymph node and operative outcomes in patients with endometrial cancer and a BMI ≥ 50: the SLOPE-50 study

Women with BMI ≥ 50 kg/m² face significant anaesthetic and surgical challenges when undergoing treatment for endometrial cancer. Evidence describing robotic-assisted surgery (RAS) outcomes in this highest-risk group is limited. To assess efficacy, peri-operative outcomes, and sentinel lymph node (SLN) mapping performance in women with BMI ≥ 50 kg/m² undergoing RAS for endometrial cancer. A retrospective review was conducted of 68 consecutive women with BMI ≥ 50 kg/m² treated at a tertiary referral cancer centre robotically for endometrial cancer or atypical hyperplasia between 2013 and 2025. Demographics, operative metrics, complications, and SLN mapping outcomes were analysed. Across 68 women, RAS was successfully completed in 62 (91.2%), with a 4.4% rate of reactive conversion to laparotomy. Most patients had substantial medical issues with 52.9% having three or more co-morbidities. Median operative time was 132 min. SLN mapping was considered appropriate in 25 of 58 cancer cases (43.1%); mapping was attempted in 18 (72.0%) and was successful in 16 (64.0%), including bilateral detection in 13 (81.3%), and 2 positive nodes (12.5%). Over the study period console and total operating time decreased significantly, and anaesthetic time remained stable. Median length of stay was 1 day. Robotic surgery is effective and appropriate in selected women with endometrial cancer and BMI ≥ 50 kg/m² when delivered within an experienced multidisciplinary pathway. SLN mapping is reliable in appropriately selected patients and can be incorporated effectively into staging strategies.