# Impact of obesity on perioperative outcomes in robot-assisted surgery for endometrial cancer: A single-center study of 119 cases

## TL;DR

This study finds that obesity increases blood loss and surgery time in robotic endometrial cancer surgery but does not reduce cancer detection effectiveness.

## Contribution

The study provides new evidence that obesity does not compromise cancer treatment outcomes in robotic surgery despite increased surgical difficulty.

## Key findings

- Obesity was linked to higher blood loss and longer surgery time in robotic endometrial cancer surgery.
- Obesity did not reduce the number of cancer-related lymph nodes retrieved during surgery.
- Hospital stay duration was influenced more by surgeon and time period than by patient BMI.

## Abstract

Whether obesity (body mass index [BMI] ≥30 kg/m²) independently affects perioperative outcomes in robot-assisted surgery for endometrial cancer remains uncertain.

We conducted a retrospective single-center cohort including 119 consecutive patients who underwent a uniform robotic procedure—total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy using the da Vinci Xi system—between November 2018 and June 2025. Patients were grouped by BMI ≥ 30 (n = 32) versus < 30 (n = 87). Outcomes were estimated blood loss (EBL), operative time, lymph-node yield, and length of stay (LOS). Multivariable linear regression adjusted for age, prior abdominal/pelvic surgery, comorbidity history (diabetes, hypertension, dyslipidemia), operating surgeon, and surgical year (2018–2020 vs 2021–2025).

BMI ≥ 30 was independently associated with higher EBL and longer operative time, and prior surgery also prolonged operative time. Surgeon effects were pronounced for efficiency and nodal retrieval; BMI was not associated with lymph-node yield. LOS was not associated with BMI; however, LOS was higher in later surgical years and varied by surgeon.

In standardized robot-assisted endometrial cancer surgery, obesity increased intraoperative workload (blood loss and operative time) without reducing lymph-node yield. LOS reflected surgeon- and time-related factors rather than BMI. These findings support the feasibility of robotic surgery in patients with obesity and underscore the importance of surgeon experience, pathway fidelity, and ongoing quality improvement.

•Obesity independently increased blood loss and operative time in robotic surgery.•BMI ≥ 30 kg/m² did not compromise pelvic lymph-node yield.•Length of stay was influenced by surgeon and surgical era, not BMI.•Standardized robotic surgery was feasible and oncologically adequate in obesity.

Obesity independently increased blood loss and operative time in robotic surgery.

BMI ≥ 30 kg/m² did not compromise pelvic lymph-node yield.

Length of stay was influenced by surgeon and surgical era, not BMI.

Standardized robotic surgery was feasible and oncologically adequate in obesity.