Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications

Cusimano, Maria C.; Simpson, Andrea; Dossa, Fahima; Liani, Valentina; Kaur, Yuvreet; Acuña, Sergio A.; Robertson, Deborah; Satkunaratnam, Abheha; Bernardini, Marcus Q.; Ferguson, Sarah E.; Baxter, Nancy N.

doi:10.1016/j.ajog.2019.05.004

Cited by 98 publications

(60 citation statements)

References 77 publications

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“…Several women included in this study described treatment delay due to cancelled or abandoned surgeries at centres with inadequate resources to manage their complexity, and this is certainly a quality of care issue that should be avoided. Women with morbid obesity would likely benefit from being managed in tertiary care centres with robotic technology,7 and many participants in this study described feeling well cared for at such centres. However, redirecting referrals to these centres must be balanced against cost and travel requirements, which were also raised by patients as significant challenges.…”

Section: Discussionmentioning

confidence: 95%

“…Participants were recruited from Princess Margaret Hospital and St. Michael’s Hospital, tertiary centres in Toronto, Canada. Unlike the majority of hospitals in the province, both centres have da Vinci surgical robots (Intuitive Surgery, Sunnyvale, California, USA), which have been shown to facilitate minimally invasive hysterectomy in patients with morbid obesity 7. As a result, these centres receive numerous surgical referrals for this population from family doctors, gynaecologists and oncologists spanning academic, community, rural and urban practices.…”

Section: Methodsmentioning

confidence: 99%

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Barriers to care for women with low-grade endometrial cancer and morbid obesity: a qualitative study

et al. 2019

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ObjectiveObesity is a major risk factor for low-grade endometrial cancer. The surgical management of patients with obesity is challenging, and they may face unique barriers to accessing care. We completed a qualitative study to understand the experiences of low-grade endometrial cancer patients with morbid obesity, from symptom onset to diagnosis to surgery.DesignSemi-structured interviews were performed with endometrial cancer patients with morbid obesity (body mass index (BMI)>40 kg/m2) referred for primary surgery. Transcribed interviews were coded line-by-line and analysed using an interpretive descriptive approach that drew on labelling theory to understand patients’ experiences. Thematic sufficiency was confirmed after 15 interviews.SettingTwo tertiary care centres in Toronto, Ontario, Canada.ParticipantsFifteen endometrial cancer patients with a median age of 61 years (range: 50–74) and a median BMI of 50 kg/m2(range: 44–70) were interviewed.ResultsThematic analysis identified that (1) both patients and providers lack knowledge on endometrial cancer and its presenting symptoms and risk factors; (2) patients with morbid obesity are subject to stigma and poor communication in the healthcare system and (3, 4) although clinical, administrative, financial, geographic and facility-related barriers exist, quality care for patients with morbid obesity is an achievable goal.ConclusionsImproved education on the prevention and identification of endometrial cancer is needed for both patients and providers. Delivery of cancer care to patients with morbid obesity may be improved through provider awareness of the impact of weight stigma and establishing streamlined care pathways at centres equipped to manage surgical complexity.

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Section: Discussionmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

Barriers to care for women with low-grade endometrial cancer and morbid obesity: a qualitative study

et al. 2019

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“…We agree with Mr Farthing that such patients should be treated surgically in tertiary centres by experts using a minimal invasive approach. We would like to add and highlight that in a recent metanalysis, robotic and laparoscopic hysterectomy were found to have similar perioperative complications (organ/vessel injury, venous thromboembolism, blood transfusion) in such patients; however, robotic hysterectomy had lower conversion rates in patients with morbid obesity, which is crucial for the enhanced recovery and safety of each such individual patient as well as the total cost in each health system 4 …”

mentioning

confidence: 97%

Re: Mirena Coil is a suitable treatment of early stage endometrial cancer in obese women: FOR or AGAINST?

Iavazzo

Gkegkes²,

Vrachnis

2020

BJOG

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“…In previous studies addressing obesity and laparoscopic operations, 12,16,24 the number of conversions has been lower in RAL than in SLP. In a recent meta‐analysis, 25 the reduction of conversion to laparotomy is higher in patients with BMI >40 (7% in SLP vs 3.8% RAL).…”

Section: Discussionmentioning

confidence: 99%

Value of robotic surgery in endometrial cancer by body mass index

Gracia

García‐Santos

Ramirez

et al. 2020

Intl J Gynecology & Obste

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Objective: To compare perioperative outcomes and complications in robotically assisted laparoscopy (RAL) and standard laparoscopy (SLP) approaches in the treatment of endometrial cancer by body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters). Methods: A comparative study was carried out of women treated for endometrial cancer at the Hospital Clinico San Carlos from January 2012 to December 2016: 133 patients were operated by RAL and 101 by SLP. Demographic characteristics of the patients, perioperative outcomes and complications were compared in both approaches. Results: Hospital stay was significantly lower in patients with BMI ≤30 operated with RAL (2 days RAL vs 4 days SLP; P=0.002). Estimated blood loss was significantly lower in the group with BMI<25 (60 mL RAL vs 100 mL SLP; P=0.004) and in the group with BMI ≥30 (87.5 mL RAL vs 180 SLP; P=0.003) operated with RAL. RAL significantly reduced the conversion rate in patients with BMI ≥30 (2 [3.4%] patients RAL vs 6 [27.3%] patients SLP; P=0.004). Conclusions: RAL has demonstrated advantages in treating obese women with endometrial cancer by reducing blood loss and conversion to laparotomy.

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Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications

Cited by 98 publications

References 77 publications

Barriers to care for women with low-grade endometrial cancer and morbid obesity: a qualitative study

Barriers to care for women with low-grade endometrial cancer and morbid obesity: a qualitative study

Re: Mirena Coil is a suitable treatment of early stage endometrial cancer in obese women: FOR or AGAINST?

Value of robotic surgery in endometrial cancer by body mass index

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