Objectives We sought to evaluate the outcome of robotic-assisted surgery for endometrial cancer in morbidly obese (MO) and extremely morbidly obese (EMO) patients.

Methods We retrospectively reviewed all robotic gynecologic oncologic surgeries performed for endometrial cancer, in women with a BMI≥40kg/m2, from 2012 to 2017 in our center. Patients were divided into two groups (MO: 40–49kg/m2, EMO: ≥50kg/m2). Complications and outcome were compared. Fisher’s test, t-test and Kaplan-Meier were used for statistical analyses.

Results Eighty-seven women were included: 64 (74%) MO and 23 (26%) EMO. The main histology was endometrioid adenocarcinoma (77% of MO and 61% of EMO) and endometrial intraepithelial neoplasia (19% of MO and 35% of EMO). The median blood loss was 100mL in MO and 75ml in EMO (p=NS). The median length of stay was one day for each group (range: 0–11). Two EMO (9%) and none of the MO patients required conversion to laparotomy due to poor surgical field exposure (p=0,067). Overall, 5 MO patients (8%) and 5 EMO (22%) had a surgical complication (p=0,12), but only 3 patients (1 MO and 2 EMO) required re-hospitalization within 30 days. The median follow-up was 47,7 months (range: 1,43–93,6). Recurrence occurred in 9% in each group, with no difference in recurrence-free survival (p=0,96). Only one MO patient died of cancer recurrence.

Conclusions The robotic-assisted surgery for endometrial cancer in morbidly obese patients is a safe and feasible procedure. The morbidly obese and extreme morbidly obese patients appear to have similar oncologic outcome, length of hospital stay, blood loss and low surgical complications.