{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T21:43:47Z","timestamp":1793310227813,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objective: Women with Class III obesity (BMI \u2265 40 kg\/m2) have a lifetime risk of endometrial cancer (EC) as high as 10\u201315%. However, evidence focused specifically on Class III obese patients remains limited. This study evaluated the surgical feasibility and safety of robotic surgery in Class III obese women with EC. Methods: A single-center retrospective study was conducted at the ESGO-accredited University Hospital of Parma (Italy) from October 2021 to February 2025. All women had apparent early-stage EC and underwent robotic hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node (SLN) mapping with Indocyanine Green. Patients were categorized into three BMI groups: Group A (BMI \u2265 40 kg\/m2), Group B (BMI 30\u201339 kg\/m2), and Group C (BMI &lt; 30 kg\/m2). Perioperative variables\u2014including operative time, estimated blood loss, conversion to laparotomy, intra- and postoperative complications, hospital and Intensive Care Unit (ICU) stay, and SLN mapping failure\u2014were compared across groups. Results: A total of 109 women were included: 26 (23.9%) in Group A, 45 (41.3%) in Group B, and 38 (34.9%) in Group C. Class III obesity was not associated with higher intraoperative (p = 0.390) or postoperative (p = 0.805) complication rates. Conversion to laparotomy (p = 0.720), estimated blood loss (p = 0.123), ICU stay (p = 0.156), and hospital stay (p = 0.491) were superimposable across groups. Operative time was significantly longer in Group A (p = 0.003) compared to the other groups. Successful bilateral SLN mapping differed significantly across groups (p = 0.026), being lower in Group A (73.1%) compared to Group B (95.6%) and Group C (81.6%). Conclusions: Robotic surgery is safe and feasible in Class III obese EC patients, with perioperative morbidity comparable to that of lower BMI groups. Nevertheless, longer operative times and a lower rate of successful bilateral SLN mapping highlight the need for tailored strategies and further research to optimize nodal staging in severely obese women.<\/jats:p>","DOI":"10.3390\/cancers18040706","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T14:05:11Z","timestamp":1771855511000},"page":"706","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Robotic Surgical Outcomes in Endometrial Cancer: Does Class III Obesity Matter?"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4720-5663","authenticated-orcid":false,"given":"Vito Andrea","family":"Capozzi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asya","family":"Gallinelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7236-8028","authenticated-orcid":false,"given":"Elisa","family":"Scarpelli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7848-0329","authenticated-orcid":false,"given":"Stefano","family":"Restaino","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, \u201cSanta Maria della Misericordia\u201d University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2424-2691","authenticated-orcid":false,"given":"Giuseppe","family":"Vizzielli","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, \u201cSanta Maria della Misericordia\u201d University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2324-5409","authenticated-orcid":false,"given":"Roberto","family":"Berretta","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Parma, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1016\/S0140-6736(24)01210-8","article-title":"Obesity in Adults","volume":"404","author":"Lingvay","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/S0140-6736(25)00355-1","article-title":"Global, Regional, and National Prevalence of Adult Overweight and Obesity, 1990\u20132021, with Forecasts to 2050: A Forecasting Study for the Global Burden of Disease Study 2021","volume":"405","author":"Ng","year":"2025","journal-title":"Lancet"},{"key":"ref_3","unstructured":"WHO Consultation (2000). Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. World Health Organ. Tech. Rep. Ser., 894, 1\u2013253."},{"key":"ref_4","unstructured":"Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (1998). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults-The Evidence Report. National Institutes of Health. Obes. Res., 6, 51S\u2013209S."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/S0140-6736(22)00323-3","article-title":"Endometrial Cancer","volume":"399","author":"Crosbie","year":"2022","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1056\/NEJMra1514010","article-title":"Endometrial Cancer","volume":"383","author":"Lu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1093\/aje\/kwae178","article-title":"Trends in Endometrial Cancer Incidence in the United States by Race\/Ethnicity and Age of Onset from 2000 to 2019","volume":"194","author":"Rodriguez","year":"2025","journal-title":"Am. J. Epidemiol."},{"key":"ref_8","first-page":"88","article-title":"Global Patterns in Excess Body Weight and the Associated Cancer Burden","volume":"69","author":"Sung","year":"2019","journal-title":"CA Cancer J. Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"689.e1","DOI":"10.1016\/j.ajog.2016.01.175","article-title":"Obesity and Endometrial Hyperplasia and Cancer in Premenopausal Women: A Systematic Review","volume":"214","author":"Wise","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1056\/NEJMoa021423","article-title":"Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults","volume":"348","author":"Calle","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1007\/s00404-025-08158-5","article-title":"Robotic-Assisted Surgery in Extremely Obese Patients: A Multidisciplinary Approach for a Patient with a BMI of 101.7 kg\/m2","volume":"312","author":"Csorba","year":"2025","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/ACO.0000000000000987","article-title":"Anesthetic Management for Robotic Hysterectomy in Obese Women","volume":"34","author":"Yurashevich","year":"2021","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"(2015). Committee Opinion No. 619. Gynecologic surgery in the obese woman. Obstet. Gynecol., 125, 274\u2013278.","DOI":"10.1097\/01.AOG.0000459870.06491.71"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hottenrott, S., Schlesinger, T., Helmer, P., Meybohm, P., Alkatout, I., and Kranke, P. (2020). Do Small Incisions Need Only Minimal Anesthesia?\u2014Anesthetic Management in Laparoscopic and Robotic Surgery. J. Clin. Med., 9.","DOI":"10.3390\/jcm9124058"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ronsini, C., Fordellone, M., Braca, E., Di Donna, M.C., Solazzo, M.C., Cucinella, G., Scaffa, C., De Franciscis, P., and Chiantera, V. (2025). Safety and Efficacy Outcomes of Robotic, Laparoscopic, and Laparotomic Surgery in Severe Obese Endometrial Cancer Patients: A Network Meta-Analysis. Cancers, 17.","DOI":"10.3390\/cancers17122018"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1016\/j.ejso.2018.08.021","article-title":"Laparoscopic versus Robotic Hysterectomy in Obese and Extremely Obese Patients with Endometrial Cancer: A Multi-Institutional Analysis","volume":"44","author":"Corrado","year":"2018","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_17","first-page":"161","article-title":"Surgeons\u2019 Fatigue in Minimally Invasive and Open Surgery: A Review of the Current Literature","volume":"92","author":"Campetella","year":"2025","journal-title":"Urol. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.asjsur.2022.06.077","article-title":"The Effectiveness of Extremely Low-Pressure Pneumoperitoneum on Pain Reduction after Robot-Assisted Cholecystectomy","volume":"46","author":"Park","year":"2023","journal-title":"Asian J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Capozzi, V., Scarpelli, E., Armano, G., Monfardini, L., Celardo, A., Munno, G., Fortunato, N., Vagnetti, P., Schettino, M., and Grassini, G. (2022). Update of Robotic Surgery in Benign Gynecological Pathology: Systematic Review. Medicina, 58.","DOI":"10.3390\/medicina58040552"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2863","DOI":"10.2147\/CMAR.S544386","article-title":"Robotic-Assisted vs Conventional Laparoscopy for Endometrial Cancer Staging: A Comparative Two-Center Study","volume":"17","author":"Januszewski","year":"2025","journal-title":"Cancer Manag. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ygyno.2023.02.014","article-title":"Robotic-Assisted Surgery for Endometrial Cancer Is Safe in Morbidly and Extremely Morbidly Obese Patients","volume":"172","author":"Lechartier","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.ajog.2019.05.004","article-title":"Laparoscopic and Robotic Hysterectomy in Endometrial Cancer Patients with Obesity: A Systematic Review and Meta-Analysis of Conversions and Complications","volume":"221","author":"Cusimano","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ygyno.2024.01.051","article-title":"The Impact of Body Mass Index on Robotic Surgery Outcomes in Endometrial Cancer","volume":"185","author":"Kadoch","year":"2024","journal-title":"Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.3802\/jgo.2023.34.e85","article-title":"FIGO Staging of Endometrial Cancer: 2023","volume":"34","author":"Berek","year":"2023","journal-title":"J. Gynecol. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e423","DOI":"10.1016\/S1470-2045(25)00167-6","article-title":"ESGO\u2013ESTRO\u2013ESP Guidelines for the Management of Patients with Endometrial Carcinoma: Update 2025","volume":"26","author":"Concin","year":"2025","journal-title":"Lancet Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.ygyno.2015.12.028","article-title":"Comparison of a Sentinel Lymph Node and a Selective Lymphadenectomy Algorithm in Patients with Endometrioid Endometrial Carcinoma and Limited Myometrial Invasion","volume":"140","author":"Eriksson","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo Classification of Surgical Complications","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1007\/s00268-023-07203-1","article-title":"Defining Feasibility as a Criterion for Essential Surgery: A Qualitative Study with Global Children\u2019s Surgery Experts","volume":"47","author":"Abbas","year":"2023","journal-title":"World J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1136\/ijgc-2023-005197","article-title":"Robotic-Assisted versus Conventional Laparoscopic Surgery in the Management of Obese Patients with Early Endometrial Cancer in the Sentinel Lymph Node Era: A Randomized Controlled Study (RObese)","volume":"34","author":"Dinoi","year":"2024","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1097\/IGC.0000000000001260","article-title":"The Feasibility of Laparoscopic Surgery in Gynecologic Oncology for Obese and Morbidly Obese Patients","volume":"28","author":"Peng","year":"2018","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1089\/gyn.2012.0142","article-title":"Influence of Morbid Obesity on Surgical Outcomes in Robotic-Assisted Gynecologic Surgery","volume":"30","author":"Eddib","year":"2014","journal-title":"J. Gynecol. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1111\/j.1600-0412.2011.01253.x","article-title":"Robot-assisted Laparoscopic Hysterectomy in Obese and Morbidly Obese Women: Surgical Technique and Comparison with Open Surgery","volume":"90","author":"Geppert","year":"2011","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5114\/ait\/203168","article-title":"Anesthesia for Robot-Assisted Surgery: A Review","volume":"57","author":"Barud","year":"2025","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Arcieri, M., Paparcura, F., Giorgiutti, C., Taliento, C., Bogani, G., Driul, L., Greco, P., Ercoli, A., Chiantera, V., and Fanfani, F. (2025). Robotic Surgery in Severely Obese Frail Patients for the Treatment of Atypical Endometrial Hyperplasia and Endometrial Cancer: A Propensity-Match Analysis at an ESGO-Accredited Center. Cancers, 17.","DOI":"10.3390\/cancers17030482"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Papageorgiou, D., Zachariou, E., Sapantzoglou, I., Tsakos, E., Xydias, E.M., Dimitroulis, D., and Plevris, N. (2025). Impact of Body Mass Index on Robotic Surgery Outcomes in Early-Stage Endometrial Cancer: A Retrospective Cohort Study. Cancers, 17.","DOI":"10.3390\/cancers17213570"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.ygyno.2022.03.003","article-title":"Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Apparent Early-Stage Endometrial Cancer: The ObeLyX Study","volume":"165","author":"Vargiu","year":"2022","journal-title":"Gynecol. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1136\/ijgc-2020-002315","article-title":"Development of a Surgical Competency Assessment Tool for Sentinel Lymph Node Dissection by Minimally Invasive Surgery for Endometrial Cancer","volume":"31","author":"Moloney","year":"2021","journal-title":"Int. J. Gynecol. Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/4\/706\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T14:12:46Z","timestamp":1771855966000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/4\/706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,22]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["cancers18040706"],"URL":"https:\/\/doi.org\/10.3390\/cancers18040706","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,22]]}}}