Robotic surgery in supermorbidly obese patients with endometrial cancer
Robotic surgery in supermorbidly obese patients with endometrial cancer
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DOI：
10.1016/j.ajog.2015.01.052
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发表时间：
2015-07-01
影响因子：
9.8
通讯作者：
Bender, David
中科院分区：
文献类型：
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作者：
Stephan, Jean-Marie;Goodheart, Michael J.;Bender, David
目的：病态肥胖是子宫内膜癌发生的已知危险因素。几项研究已经证明了机器人辅助子宫内膜癌手术分期的总体可行性，以及机器人与开腹手术相比的好处。然而，在超重肥胖人群中评价机器人手术治疗子宫内膜癌的报道很少(体重指数=50公斤/米(2))。我们试图评估超重肥胖患者接受机器人手术治疗子宫内膜癌的安全性、可行性和结果，并与体重指数较低的患者进行比较。STUDY设计：我们对168名疑似早期子宫内膜腺癌患者进行了回顾性图表回顾，这些患者接受了机器人手术来管理他们的疾病。采用方差分析和单变量Logistic回归分析比较所有体重的患者特征和手术变量。用COX比例风险回归分析体重对无复发和总生存率的影响。结果：我们队列的平均BMI为40.9 kg/m(2)。中位随访时间为31个月。56名患者，其中30%有2级或3级肿瘤，超病态肥胖，BMI=50 kg/m(2)，平均为56.3 kg/m(2)。超病态肥胖患者和体重较低患者之间的比较显示，在住院时间、失血量、并发症发生率、盆腔和腹主动脉旁淋巴结被取回的数量、复发和存活率方面没有差异。BMI与中转开放手术有相关性，中转几率随BMI增加而增加(P=0.02)。结论：为超重肥胖的子宫内膜癌患者提供机器人手术是一种安全可行的手术方式。与体重指数较低的患者相比，异常肥胖的患者在住院时间、出血量、并发症和取回淋巴结的数量方面都有相似的结果。
OBJECTIVE: Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], >= 50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices.STUDY DESIGN: We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival.RESULTS: The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of >= 50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02).CONCLUSION: Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph nodes retrieved.