Oncological Outcomes of Obese Patients in Treatment of Endometrial Cancer. Comparative Analysis of Robotic Versus Laparoscopic Surgery

Abstract

<h3>Study Objective</h3> To compare and evaluate long term oncological outcomes of robotic versus laparoscopic surgery in the treatment of endometrial cancer for obese, morbidly obese, and super morbidly obese patients. <h3>Design</h3> A prospective cohort of patients who underwent robotic-assisted hysterectomy with lymphadenectomy (RHLND) were compared to total laparoscopic hysterectomy with lymphadenectomy (LHLND) were analyzed for the long-term oncological outcomes of recurrence rate and overall survival (OS). <h3>Setting</h3> Tertiary Hospital <h3>Patients or Participants</h3> From 03/1999-03/2018, patients with BMI >30 who underwent minimally invasive surgical treatment for endometrial cancer. <h3>Interventions</h3> Demographics, pathologic characteristics for stage, grade and histology and adjuvant treatment received were compared between the two surgical treatment groups and analyzed for the oncological outcomes of recurrence rate and overall survival (OS). <h3>Measurements and Main Results</h3> Total of 330 patients were evaluated with 254/330 (77%) underwent RHLND and 76/330 (23%) underwent LHLND. Demographics and pathological outcomes were comparable between LHLND and RHLND when matched for age, histology, grade, and stage (FIGO 2019) with the exception of stage IB and II. Adjuvant treatment required for LHLND 28/76 (36.8%) and for RHLND 93/254 (36.6%) were equivalent. The rate of recurrence between the two groups for 10 year follow up was 7/76 (9.2%) and 36/254 (14.2%) for LHLND and RHLND respectively. The rate of recurrence showed no significant difference between the two surgical treatment groups when analyzed for Stage I disease [22/211 (10.4%) for RHLND and 6/69 (8.7%) for LHLND] and advanced stage disease [14/43(32.5%) for RHLND and 1/7 (14.2%) for LHLND]. The 10-year OS was 4/79 (5.2%) and 15/254 (5.9%) for LHLND and RHLND respectively were equivalent. <h3>Conclusion</h3> The long-term oncological outcomes between LHLND and RHLND showed no difference in recurrence rate and overall survival in a subset of obese patients with endometrial cancer.