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Surgical Endoscopy

25-09-2024 | Sleeve Gastrectomy

Combined robotic surgery for concomitant treatment of endometrial cancer and obesity

Authors: Francesco Mezzapesa, Stella Di Costanzo, Camelia Alexandra Coadă, Paolo Bernante, Francesca Balsamo, Silvia Garelli, Lucia Genovesi, Pietro Pasquini, Agnese Lambertini, Fabio Caramelli, Pierandrea De Iaco, Anna Myriam Perrone

Published in: Surgical Endoscopy

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Abstract

Background

Endometrial Cancer (EC) is strongly linked to obesity. Bariatric surgery is recognized as a long-term solution for weight loss in severely obese patients. This pilot study investigates the feasibility, intraoperative and 30-day morbidity outcomes of integrating gynecological surgical staging and bariatric robotic surgery in class II and III obese patients affected by early EC or Endometrial Intraepithelial Neoplasia (EIN).

Methods

Patients aged over 18 years old with early EC or EIN and class II and III obesity (Body mass index (BMI) ≥ 35 kg/m2) who are surgical and anesthesiologic candidates. Standard robotic surgery for early EC staging performed alone (THBSO group) or in conjunction with sleeve gastrectomy (THBSO + SG group) for obesity management was proposed.

Results

Of the 13 patients who met the inclusion criteria, 5 (38.46%) opted for combined surgery. The groups showed a significant difference in preoperative BMI (49.68 kg/m2 vs. 40.24 kg/m2 p = 0.017 with and without SG), preoperative weight (143.92 kg vs. 105.62 kg p = 0.004 with and without SG), preoperative (p = 0.01) and postoperative (p = 0.005) aspartate transaminase (AST). The THBSO + SG group had higher anesthesia induction end-tidal carbon dioxide (ETCO2) (p = 0.05), final Partial pressure of carbon dioxide (PaCO2) (p = 0.044), anesthesia induction lactate (p = 0.001) and final lactate (p = 0.011) without a significant difference in final pH (p = 0.31). Operative time was longer in the THBSO + SG group (p < 0.001), but this did not result in longer ICU (p = 0.351), total hospital stays (p = 0.208), nor increased blood loss and transfusion. The simultaneous combined approach had an 80% success rate. At 6 months, the THBSO + SG group achieved significantly greater weight loss than the THBSO group (ΔBMI − 11.81 kg/m2 vs − 1.72 kg/m2, p = 0.003, with and without SG).

Conclusion

Integrating robotic EC staging with SG in obese women with early EC increased the operative time without increasing intraoperative risks, early and 30 days post-surgery complication and offering a promising approach to simultaneously treating both conditions.
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Metadata
Title
Combined robotic surgery for concomitant treatment of endometrial cancer and obesity
Authors
Francesco Mezzapesa
Stella Di Costanzo
Camelia Alexandra Coadă
Paolo Bernante
Francesca Balsamo
Silvia Garelli
Lucia Genovesi
Pietro Pasquini
Agnese Lambertini
Fabio Caramelli
Pierandrea De Iaco
Anna Myriam Perrone
Publication date
25-09-2024
Publisher
Springer US
Published in
Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-024-11274-z
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