title: Robotic surgery in supermorbidly obese patients with endometrial cancer.
abstract: OBJECTIVE
  Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], ≥50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices.
  
  
  METHODS
  We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival.
  
  
  RESULTS
  The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of ≥50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02).
  
  
  CONCLUSIONS
  Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph nodes retrieved.
authors: Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA. Electronic address: Jean-marie-stephan@uiowa.edu.
authors: Jean-Marie
authors: JM
authors: Stephan
authors: Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors: Michael J
authors: MJ
authors: Goodheart
authors: Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors: Megan
authors: M
authors: McDonald
authors: Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors: Jean
authors: J
authors: Hansen
authors: Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors: Henry D
authors: HD
authors: Reyes
authors: Department of Biostatistics, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors: Anna
authors: A
authors: Button
authors: Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors: David
authors: D
authors: Bender
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000401:mortality; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome
keywords: endometrial cancer; obesity; robotic surgery