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The roles and limitations of robotic surgery for obese endometrial cancer patients: a common challenge in gynecologic oncology

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Abstract

In the United States, the epidemic of obesity is readily apparent in women diagnosed with endometrial cancer, the most common gynecologic malignancy. Overall, the benefits of minimally invasive surgery and its oncologic outcomes are similar among laparoscopy and robotic approaches. However, in stratifying obese patients by BMI, more data is needed on morbidly obese patients and their candidacy for robotic surgery along with the technical challenges of staging procedures. Cost analysis studies targeted specifically to the obese and morbidly obese patient is needed to further justify efforts at promoting robotic surgery in this patient population.

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References

  1. Centers for disease control and prevention. overweight and obesity (2014). http://www.cdc.gov/obesity/adult/index.html. Accessed 10 Oct 2014

  2. Classification BMI (2006) Global database on body mass index. World Health Organization, Geneva

    Google Scholar 

  3. Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307(5):491–497

    Article  PubMed  Google Scholar 

  4. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Spiegel G, Barakat R, Pearl ML, Sharma SK (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2. J Clin Oncol 27(32):5331–5336

    Article  PubMed Central  PubMed  Google Scholar 

  5. Ramirez PT, Adams S, Boggess JF, Burke WM, Frumovitz MM, Gardner GJ, Havrilesky LJ, Holloway R, Lowe MP, Magrina JF, Moore DH, Soliman PT, Yap S (2012) Robotic-assisted surgery in gynecologic oncology: a Society of gynecologic oncology consensus statement. Developed by the Society of gynecologic oncology’s clinical practice robotics task force. Gynecol Oncol 124(2):180–184

    Article  PubMed  Google Scholar 

  6. Seamon LG, Bryant SA, Rheaume PS, Kimball KJ, Huh WK, Fowler JM, Phillips GS, Cohn DE (2009) Comprehensive surgical staging for endometrial cancer in obese patient, comparing robotics and laparotomy. Obstet Gynecol 114(1):16–21

    Article  PubMed  Google Scholar 

  7. Seamon LG, Cohn DE, Henretta MS, Kim KH, Carlson MJ, Phillips GS, Fowler JM (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or Laparoscopy? Gynecol Oncol 113(1):36–41

    Article  PubMed  Google Scholar 

  8. Subramaniam A, Kim KH, Bryant SA, Zhang B, Sikes C, Kimball KJ, Kilgore LC, Huh WK, Straughn JM Jr, Alvarez RD (2011) A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma. Gynecol Oncol 122(3):604–607

    Article  PubMed  Google Scholar 

  9. Bernardini MQ, Gien LT, Tipping H, Murphy J, Rosen BP (2012) Surgical outcome of robotic surgery in morbidly obese patient with endometrial cancer compared to laparotomy. Int J Gynecol Cancer 22(1):76–81

    Article  PubMed  Google Scholar 

  10. Tang KY, Gardiner SK, Gould C, Osmundsen B, Collins M, Winter WE 3rd (2012) Robotic surgical staging for obese patients with endometrial cancer. Am J Obstet Gynecol 206(6):513

    PubMed  Google Scholar 

  11. DeNardis SA, Holloway RW, Bigsby GE 4th, Pikaart DP, Ahmad S, Finkler NJ (2008) Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol 111(3):412–417

    Article  PubMed  Google Scholar 

  12. Jones N, Fleming ND, Nick AM, Munsell MF, Rallapalli V, Westin SN, Meyer LA, Schmeler KM, Ramirez PT (2014) Soliman PT conversion from robotic surgery to laparotomy: a case-control study evaluating risk factors for conversion. Gynecol Oncol 134(2):238–242

    Article  PubMed  Google Scholar 

  13. Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF (2008) What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 111(1):41–45

    Article  PubMed  Google Scholar 

  14. ElSahwi KS, Hooper C, De Leon MC, Gallo TN, Ratner E, Silasi DA, Santin AD, Schwartz PE, Rutherford TJ, Azodi M (2012) Comparison between 155 cases of robotic versus 150 cases of open surgical staging for endometrial cancer. Gynecol Oncol 124(2):260–264

    Article  PubMed  Google Scholar 

  15. Menderes G, Azodi M, Clark L, Xu X, Lu L, Ratner E, Schwartz PE, Rutherford TJ, Santin AD, Silasi DA (2014) Impact of body mass index on surgical outcomes and analysis of disease recurrence for patients with endometrial cancer undergoing robotic-assisted staging. Int J Gynecol Cancer 24(6):1118–1125

    Article  PubMed  Google Scholar 

  16. Lau S, Buzaglo K, Vaknin Z, Brin S, Kaufer R, Drummond N, Gourdji I, Aubin S, Rosberger Z, Gotlieb WH (2011) Relationship between body mass index and robotic surgery outcomes of women diagnosed with endometrial cancer. Int J Gynecol Cancer 21(4):722–729

    Article  PubMed  Google Scholar 

  17. Gallo T, Kashani S, Patel DA, Elsahwi K, Silasi DA, Azodi M (2012) Robotic-assisted laparoscopic hysterectomy: outcomes in obese and morbidly obese patients. JSLS 16(3):421–427

    Article  PubMed Central  PubMed  Google Scholar 

  18. Geppert B, Lönnerfors C, Persson J (2011) Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery. Acta Obstet Gynecol Scand 90(11):1210–1217

    Article  PubMed  Google Scholar 

  19. Backes FJ, Brudie LA, Farrell MR, Ahmad S, Finkler NJ, Bigsby GE, O’Malley D, Cohn DE, Holloway RW, Fowler JM (2012) Short- and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging. Gynecol Oncol 125(3):546–551

    Article  PubMed  Google Scholar 

  20. Abu-Rustum NR (2014) Sentinel lymph node mapping for endometrial cancer: a modern approach to surgical staging. J Natl Compr Canc Netw 12(2):288–297

    PubMed  Google Scholar 

  21. Sinno AK, Fader AN, Roche KL, Giuntoli RL 2nd, Tanner EJ (2014) A comparison of colorimetric versus fluorometric sentinel lymph node mapping during robotic surgery for endometrial cancer. Gynecol Oncol 134(2):281–286

    Article  PubMed  Google Scholar 

  22. Fader AN, Seamon LG, Escobar PF, Frasure HE, Havrilesky LA, Zanotti KM, Secord AA, Boggess JF, Cohn DE, Fowler JM, Skafianos G, Rossi E, Gehrig PA (2012) Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: a multi-site study performed at high volume cancer centers. Gynecol Oncol 126(2):180–185

    Article  PubMed  Google Scholar 

  23. Brudie LA, Backes FJ, Ahmad S, Zhu X, Finkler NJ, Bigsby GE 4th, Cohn DE, O’Malley D, Fowler JM, Holloway RW (2013) Analysis of disease recurrence and survival for women with uterine malignancies undergoing robotic surgery. Gynecol Oncol 128(2):309–315

    Article  PubMed  Google Scholar 

  24. Abitbol J, Lau S, Ramanakumar AV, Press JZ, Drummond N, Rosberger Z, Aubin S, Gotlieb R, How J, Gotlieb WH (2014) Prospective quality of life outcomes following robotic surgery in gynecologic oncology. Gynecol Oncol 134(1):144–149

    Article  PubMed  Google Scholar 

  25. Wright JD, Ananth CV, Tergas AI, Herzog TJ, Burke WM, Lewin SN, Lu YS, Neugut AI, Hershman DL (2014) An economic analysis of robotically assisted hysterectomy. Obstet Gynecol 123(5):1038–1048

    Article  PubMed Central  PubMed  Google Scholar 

  26. Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S (2008) Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol 111(3):407–411

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors Drs. Shemshedini, Pradhan, Pua and Tedjarati have no conflicts of interest to report.

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Correspondence to Teuta Shemshedini.

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Shemshedini, T., Pradhan, T.S., Pua, T.L. et al. The roles and limitations of robotic surgery for obese endometrial cancer patients: a common challenge in gynecologic oncology. J Robotic Surg 9, 109–116 (2015). https://doi.org/10.1007/s11701-015-0509-0

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  • DOI: https://doi.org/10.1007/s11701-015-0509-0

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