Ronsini Carlo, Fordellone Mario, Braca Eleonora, Di Donna Mariano Catello, Solazzo Maria Cristina, Cucinella Giuseppe, Scaffa Cono, De Franciscis Pasquale, Chiantera Vito
Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione "G. Pascale", 80131 Naples, Italy.
Medical Statistics Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Cancers (Basel). 2025 Jun 17;17(12):2018. doi: 10.3390/cancers17122018.
The surgical management of endometrial cancer in severely obese patients (BMI ≥ 40) presents unique challenges. This study evaluates the outcomes of various surgical approaches in terms of safety and efficacy in lymph node retrieval.
A systematic review and network meta-analysis focused on intra-operative complications, post-operative complications, severe complications, and complete surgical staging rates. The analysis included 1163 patients, following a pre-specified methodology based on the PRISMA-NMA guidelines. The study was registered on PROSPERO with protocol number CRD 395959.
Intra-operative complications: No significant difference was found between minimally invasive surgery (MIS, 233 patients) and laparotomy (LPT) (OR 0.68 [95% CI 0.21-2.26], = 0.18). However, robotic surgery showed a significantly lower risk (OR 0.28 [0.10-0.74]). Post-operative complications: The MIS group (457 patients) had a lower risk compared to LPT (OR 0.41 [0.26-0.64]). Network analysis: Robotic surgery had a 70.7% probability of reducing intra-operative complications compared to laparoscopy (LPS) and a 99.2% probability compared to LPT. Laparoscopy was the safest option for post-operative complications, with a 74.3% probability. Robotic surgery had an 82.4% probability of achieving complete surgical staging compared to LPT.
Robotic surgery shows superior outcomes for complete lymph nodal staging in obese endometrial cancer patients, while LPS is favorable for post-operative complications. Further studies are needed to optimize strategies.
严重肥胖患者（BMI≥40）的子宫内膜癌手术治疗面临独特挑战。本研究评估了各种手术方法在淋巴结清扫方面的安全性和有效性。
进行一项系统评价和网状Meta分析，重点关注术中并发症、术后并发症、严重并发症和完整手术分期率。该分析纳入了1163例患者，遵循基于PRISMA-NMA指南的预先指定方法。该研究已在PROSPERO注册，注册号为CRD 395959。
术中并发症：微创手术（MIS，233例患者）与开腹手术（LPT）之间未发现显著差异（OR 0.68 [95%CI 0.21 - 2.26]，P = 0.18）。然而，机器人手术的风险显著较低（OR 0.28 [0.10 - 0.74]）。术后并发症：MIS组（457例患者）的风险低于LPT组（OR 0.41 [0.26 - 0.64]）。网状分析：与腹腔镜手术（LPS）相比，机器人手术降低术中并发症的概率为70.7%，与LPT相比为99.2%。腹腔镜手术是术后并发症最安全的选择，概率为74.3%。与LPT相比，机器人手术实现完整手术分期的概率为82.4%。
机器人手术在肥胖子宫内膜癌患者的完整淋巴结分期方面显示出更好的效果，而腹腔镜手术在术后并发症方面更具优势。需要进一步研究以优化策略。
