| BackgroundEndometrial cancer is one of the common malignant tumors of the female reproductive system in China,while the morbidity and mortality are increasing year by year.With the improvement of living standards,the number of obese patients with endometrial cancer has increased significantly,bringing new challenges to clinical treatment.Obese people will extend the surgical incision during the traditional open surgery due to the accumulation of fatty tissue,which undoubtedly increases the risk of wound infection and fat liquefaction.With the development of surgical technology,laparoscopic minimally invasive technology is gradually applied in the field of gynecology,which not only reduces the surgical trauma and shortens the operation time,but also reduces the risk of peri-operative complications.However,the vision and operation space of laparoscopy are limited for obese patients with endometrial cancer,and it is difficult to perform surgical operation in a small space,which increases the risk of the operation and affects the operation efficacy.The da Vinci robotic surgery system has the three-dimensional high-definition field of vision and flexible Endowrist surgical instruments,which improve the accuracy and precision of the operation greatly,and these advantages may make up for the shortcomings of traditional laparoscopic technique.At present,a large number of domestic and foreign literatures mainly focus on the pathogenesis of obesity and endometrial cancer,while perioperative indicators,complications and long-term prognostic are relatively few.This study retrospectively analyzed the clinical data of obese patients with endometrial cancer undergoing the minimally invasive surgery,and aimed to explore the advantages,safety and effectiveness of the da Vinci robotic surgery system in obese patients with endometrial cancer.ObjectiveTo analyze the clinical data of da Vinci robot and traditional laparoscopy in the treatment of obese patients with endometrial cancer,and explore the safety and efectiveness of the da Vinci robotic surgery system in obese patients with endometrial cancer.MethodsWe retrospectively analyzed the clinical data of 208 obese patients with endometrial cancer(BMI>30 kg/m2)who underwent endometrial cancer staging surgery in the First Affiliated Hospital of Zhengzhou University from August 2014 to June 2020.61 cases underwent da Vinci robotic surgery and 147 cases underwent conventional laparoscopic surgery.The general information,peri-operative indicators,recurrence,progression-free survival and overall survival were analyzed and compared between the two groups.The date was analyzed by independent sample t-test and χ2 test in SPSS 22.0,Kaplan-Meier was used to construct the survival curve,the Log-rank test was used to compare the survival rates of different subgroups and COX regression was used to analyze the risk factors of recurrence.P<0.05 was considered statistically significant.Results1.All the basic characteristics(age,BMI,history of abdominal surgery,comorbidities,FIGO stage,pathological type,histological grade,the score of Caprini Thrombosis Assessment Scale and the postoperative adjuvant treatment)of the two groups were not statistically different(P>0.05).2.One case of ureteral injury occurred during the robotic operation,and 2 cases of traditional laparoscopy were converted to laparotomy due to inadequate exposure.The operation time of the robotic group was longer than that of the traditional laparoscopic group((200.57±34.10)vs(179.02±37.31)min,P=0.000),and the intraoperative blood loss in the robotic group was less than that of the traditional laparoscopic group((81.31±51.95)vs(102.59±57.10)ml,P=0.013).The number of pelvic lymph nodes(21(13～48)vs 19(10～46),P=0.024),para-aortic lymph nodes(8(2～21)vs 5.5(1～20),P=0.000)and total lymph nodes(29(18～48)vs 23(10～57),P=0.000)resected were higher in robotic group than in traditional laparoscopic group.3.The postoperative exhaust time((2.26±0.48)vs(2.45±0.56)d,P=0.024)and postoperative hospitalization days((7.61±2.80)vs(8.72±3.49)d,P=0.028)of the robotic group was shorter than that of the traditional laparoscopic group.The cost of hospitalization in the robotic group was significantly higher((7.52×10±1.29×104)vs(5.49×104±1.28×104)yuan,P=0.000).There was no significant difference between the two groups in the postoperative extubation time and the incidence of postoperative complications(P>0.05).4.The robotic group was followed up for(29.21±12.12)months,and the traditional laparoscopic group was followed up for(33.19±15.52)months.There was no significant difference in follow-up time,progression-free survival and overall survival between the two groups(P>0.05).Conclusion1.The application of da Vinci robotic surgery system in obese patients with endometrial cancer is safe and feasible.2.Compared with traditional laparoscopic surgery，da Vinci robotic surgery in obese patients with endometrial cancer is associated with less intraoperative blood loss,more pelvic lymph nodes,para-aortic lymph nodes and total lymph nodes resected.Moreover,the gastrointestinal function recovery is earlier,and the length of postoperative hospitalization is shorter.3.Da Vinci robotic surgery has a similar short-term recurrence rate and survival prognosis for obese patients with endometrial cancer compared with the traditional laparoscopic surgery. |
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