Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Surg Endosc. 2024 Nov;38(11):6691-6699. doi: 10.1007/s00464-024-11274-z. Epub 2024 Sep 25.
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).
Patients aged over 18 years old with early EC or EIN and class II and III obesity (Body mass index (BMI) ≥ 35 kg/m) 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.
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/m vs. 40.24 kg/m 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/m vs - 1.72 kg/m, p = 0.003, with and without SG).
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.
子宫内膜癌（EC）与肥胖密切相关。减重手术被认为是严重肥胖患者长期减肥的一种方法。本研究旨在探讨对患有早期 EC 或子宫内膜上皮内瘤变（EIN）的 II 类和 III 类肥胖（BMI≥35kg/m）患者进行妇科外科分期和减重机器人手术的可行性、术中及 30 天发病率结果。
选择年龄大于 18 岁、患有早期 EC 或 EIN 且肥胖（BMI≥35kg/m）的患者，且为手术和麻醉候选人。建议对早期 EC 患者行标准机器人手术分期（THBSO 组）或结合袖状胃切除术（THBSO+SG 组）进行肥胖管理。
符合纳入标准的 13 例患者中，5 例（38.46%）选择联合手术。两组患者术前 BMI（49.68kg/m 与 40.24kg/m，p=0.017，有和无 SG）、术前体重（143.92kg 与 105.62kg，p=0.004，有和无 SG）、术前（p=0.01）和术后（p=0.005）天门冬氨酸转氨酶（AST）差异有统计学意义。THBSO+SG 组麻醉诱导呼气末二氧化碳（ETCO2）（p=0.05）、终末 PaCO2（p=0.044）、麻醉诱导时乳酸（p=0.001）和终末乳酸（p=0.011）较高，而终末 pH 无显著差异（p=0.31）。THBSO+SG 组的手术时间较长（p<0.001），但 ICU 入住时间（p=0.351）、总住院时间（p=0.208）、出血量和输血均无差异。同期联合组成功率为 80%。6 个月时，THBSO+SG 组体重减轻明显优于 THBSO 组（ΔBMI-11.81kg/m 与-1.72kg/m，p=0.003，有和无 SG）。
在肥胖的早期 EC 妇女中，将机器人 EC 分期与 SG 联合应用增加了手术时间，但没有增加术中风险、术后早期和 30 天并发症的发生率，并为同时治疗两种疾病提供了一种有前途的方法。
