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

Obesity is one of the most significant challenges in the management of endometrial carcinoma, as it complicates surgical treatment by limiting technical options and increasing the risk of complications. Our analysis set out to determine which surgical approach is safest and most effective for patients with a BMI ≥ 40. While our meta-analysis did not identify a statistically significant difference in safety between the available surgical methods, minimally invasive surgery (MIS) demonstrated a favorable trend, with lower rates of intra-operative and post-operative complications, as well as a higher likelihood of achieving complete surgical staging with bilateral sentinel lymph node removal. Notably, our network meta-analysis—which allows an indirect comparison of all three approaches—found that robotic surgery appears to be the most effective in minimizing intra-operative complications and achieving complete lymph node staging while performing similarly to laparoscopy in reducing post-operative complications. These findings suggest that robotic surgery could be considered the gold standard in terms of safety and efficacy for this patient population, supporting the centralization of care in specialized centers equipped with robotic systems. However, it is important to recognize that access to robotic surgery may be limited by equipment availability and cost, potentially impacting equitable patient care