Article Text
PDF
Statistics from Altmetric.com
- Obesity, Morbid
- Endometrial Neoplasms
- Gynecologic Surgical Procedures
- Surgical Procedures, Operative
- Sentinel Lymph Node
Endometrial cancer is the most common gynecological tumor, with approximately 10 200 new cases in 2022 in Italy.1 Its incidence is on the rise, possibly linked to undefined factors, with many attributing it to the increasing rates of obesity in high-income countries. This is not an unreasonable assumption, considering the correlation between obesity and the general risk of cancer, as well as the effects of unopposed hyperestrogenism due to inadequate progesterone production from adipose tissue.2
Strong evidence from the literature underscores the health benefits of weight reduction. It is particularly noteworthy for women with pre-cancerous lesions and early-stage tumors who wish to conceive.3 Rapid and significant weight loss can be achieved through bariatric surgery, and the combination of minimally invasive robotic surgery with sleeve gastrectomy seems to be a promising option for severely obese women (body mass index (BMI) >35 kg/m2) (Figure 1). This choice is supported by the minimally invasive approach recommended for endometrial cancer and the surgeon’s comfort with the robotic technique in severely obese patients4 (Online Supplemental File 1).
Supplemental material
(Left) Robotic Assisted Total Hysterectomy: dissection of the left round ligament and development of the vesico-uterine plica. (Right) Sleeve gastrectomy using a linear mechanical stapler.
Our experience has shown a significant and swift weight reduction in patients treated with this combined approach, which is often difficult to attain with various diets. Notably, patients typically have a history of repeated and prolonged attempts at various diets with no success. The surgical procedures have been free of short- and long-term complications, and adding the bariatric component to laparoscopy has not increased transfusion requirements or the need for intensive care. The average length of stay in hospital was about the same for patients with and without bariatric surgery, with similar times for dietary refeeding, recovery of other bodily functions such as bowel and urinary function, drain removal, and pain management.
However, it is essential to underline the patients' limited compliance with accepting the combined procedure, with only 3 out of 13 patients potentially eligible for bariatric surgery. The reasons were not investigated with specific tools, but the consistent responses included the illusion that yet another diet could change their weight without resorting to bariatric surgery, and a lack of full awareness of their overweight status and its implications for their overall health.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors All authors provided substantial contributions to the final video and had the opportunity to review and approve the planned submission. AMP, FM, PDI: methodology, data curation, writing, visualization, project administration. PB, FB, SG: methodology, data curation, review and editing. AMP: guarantor. AMP, PDI: conceptualization. AMP, FM, PB, FB, SG, PDI: writing – review and editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.