Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy.

Szczegóły
Abstrakt

Tytuł:: Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy.
Autorzy:: Seamon LG; From the Divisions of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, and The University of Alabama at Birmingham, Birmingham, Alabama; and the Center for Biostatistics, the Ohio State University, Columbus, Ohio.
Bryant SA
Rheaume PS
Kimball KJ
Huh WK
Fowler JM
Phillips GS
Cohn DE
Źródło:: Obstetrics and gynecology [Obstet Gynecol] 2009 Jul; Vol. 114 (1), pp. 16-21.
Typ publikacji:: Comparative Study; Journal Article
Język:: English
Imprint Name(s):: Publication: 2004- : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: New York.
MeSH Terms:: Laparotomy*
Robotics*
Endometrial Neoplasms/*pathology
Neoplasm Staging/*methods
Obesity/*complications
Body Mass Index ; Endometrial Neoplasms/surgery ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes/pathology
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Straughn JM, Huh WK, Kelly FJ, Leath CA 3rd, Kleinberg MJ, Hyde J Jr, et al. Conservative management of stage I endometrial carcinoma after surgical staging. Gynecol Oncol 2002;84:194–200.
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Entry Date(s):: Date Created: 20090624 Date Completed: 20090820 Latest Revision: 20210107
Update Code:: 20240104
DOI:: 10.1097/AOG.0b013e3181aa96c7
PMID:: 19546753
: Czasopismo naukowe

Objective: To compare adequacy and outcomes of surgical staging for endometrial cancer in obese women by robotics or laparotomy.
Methods: Clinical stage I or occult stage II endometrial cancer patients with body mass indexes (BMIs) of at least 30 (BMI is calculated as weight (kg)/[height (m)]2) were identified undergoing robotic staging and matched 1:2 with laparotomy patients. Patient characteristics, operative times, complications, and pathologic factors were collected. An adequate lymphadenectomy was defined arbitrarily as at least 10 total nodes removed, and adequate pelvic and paraaortic lymphadenectomy was defined as at least six and at least four nodes removed, respectively.
Results: A total of 109 patients underwent surgery with the intent of robotic staging and were matched to 191 laparotomy patients. The mean BMI was 40 for each group. The robotic conversion rate was 15.6% (95% confidence interval [CI] 9.5-24.2%). Ninety-two completed robotic patients were compared with 162 matched laparotomy patients. The two groups were comparable regarding total lymph node count (25 +/- compared with 24 +/- 12, P =.45) and the percentage of patients undergoing adequate lymphadenectomy (85% compared with 91%, P=.16) and adequate pelvic (90% compared with 95%, P=.16) and aortic lymphadenectomy (76% compared with 79%, P=.70) for robotic and laparotomy patients, respectively, but there was limited power to detect this difference. The blood transfusion rate (2% compared with 9%, odds ratio [OR] 0.22, 95% CI 0.05-0.97, P=.046), the number of nights in the hospital (1 compared with 3, P<.001), complications (11% compared with 27%, OR 0.29, 95% CI 0.13-0.65 P=.003), and wound problems (2% compared with 17%, OR 0.10, 95% CI 0.02-0.43, P=.002) were reduced for robotic surgery.
Conclusion: In obese women with endometrial cancer, robotic comprehensive surgical staging is feasible. Importantly, obesity may not compromise the ability to adequately stage patients robotically.
Level of Evidence: II

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