Safety and Efficacy Outcomes of Robotic, Laparoscopic, and Laparotomic Surgery in Severe Obese Endometrial Cancer Patients: A Network Meta-Analysis

Background: The surgical management of endometrial cancer in severely obese patients (BMI ≥ 40) presents unique challenges. This study evaluates the outcomes of various surgical approaches in terms of safety and efficacy in lymph node retrieval. Methods: A systematic review and network meta-analysis focused on intra-operative complications, post-operative complications, severe complications, and complete surgical staging rates. The analysis included 1163 patients, following a pre-specified methodology based on the PRISMA-NMA guidelines. The study was registered on PROSPERO with protocol number CRD 395959. Results: Intra-operative complications: No significant difference was found between minimally invasive surgery (MIS, 233 patients) and laparotomy (LPT) (OR 0.68 [95% CI 0.21–2.26], p = 0.18). However, robotic surgery showed a significantly lower risk (OR 0.28 [0.10–0.74]). Post-operative complications: The MIS group (457 patients) had a lower risk compared to LPT (OR 0.41 [0.26–0.64]). Network analysis: Robotic surgery had a 70.7% probability of reducing intra-operative complications compared to laparoscopy (LPS) and a 99.2% probability compared to LPT. Laparoscopy was the safest option for post-operative complications, with a 74.3% probability. Robotic surgery had an 82.4% probability of achieving complete surgical staging compared to LPT. Conclusions: Robotic surgery shows superior outcomes for complete lymph nodal staging in obese endometrial cancer patients, while LPS is favorable for post-operative complications. Further studies are needed to optimize strategies.