Robotic-assisted surgery and sentinel lymph node biopsy in morbidly obese endometrial cancer patients: a...

Obesity is associated with a worse prognosis in endometrial cancer (EC) patients. While robotic surgery has overcome many technical challenges of morbid obesity, lymphadenectomies are still performed less frequently, leading to understaging and potential undertreatment in highly obese patients. We aimed to assess whether robotic-assisted laparoscopy (RAL) and the implementation of sentinel lymph node biopsy (SLNB) have enabled guideline-compliant nodal staging in morbidly obese patients. Surgical and oncological outcomes were also assessed. This retrospective single-center cohort study included all patients who underwent primary robotic surgery for EC at Tampere University Hospital, Finland, between March 2009 and December 2022. BMI stratified patients into morbidly obese (BMI ≥ 40 kg/m²) and non-morbidly obese (< 40 kg/m²) groups. Primary outcomes were nodal staging rates, bilateral sentinel lymph node (SLN) detection rates, and surgical complications. Cox regression analysis was used to assess survival outcomes. Of the 749 patients, 127 (17%) were morbidly obese and 622 (83%) had a BMI < 40. Following the implementation of SLNB, successful nodal staging was achieved in 87% of morbidly obese patients, with a bilateral SLN detection rate of 78%. Lymphadenectomies were performed less frequently in morbidly obese patients. Intraoperative and postoperative complication rates did not differ between BMI groups. No conversions were recorded in the final five years of the study. Higher BMI was associated with poorer overall survival (HR 1.04, 95% CI 1.02-1.07, p = 0.002), but not with progression-free survival or disease-specific survival. With robotic-assisted laparoscopy and SLNB, appropriate staging was achieved in most morbidly obese patients in this cohort.