Comparison of Complications Between Laparoscopic and Open Abdominal Approaches in Morbidly Obese Patients with Early-Stage Endometrial Carcinoma

Abstract

Background. Endometrial carcinoma is the most common gynecological malignancy globally. Its rising incidence is closely linked to the increasing prevalence of morbid obesity (BMI > 40 kg/m2), which elevates the technical difficulty of surgery and the risk of perioperative complications. Identifying the optimal surgical approach is critical for this high-risk population.

Patients and methods. This retrospective study with prospectively collected data compared laparoscopic (LPSC) versus open abdominal (LAP) surgical approaches for low risk endometrioid carcinoma in morbidly obese patients. Data were collected over an eleven-year period (January 2013–December 2023) and included 73 patients (58 LPSC, 15 LAP) who met the inclusion criteria (BMI > 40 kg/m2, low-grade, early-stage endometrioid carcinoma). Outcomes measured included operative time, intraoperative blood loss, length of hospital stay, and intraoperative/postoperative complications, which were rigorously classified using the Clavien-Dindo system.

Results. Baseline patient characteristics were comparable between the two groups. The LPSC group demonstrated significantly superior perioperative outcomes. The average postoperative hospital stay was markedly shorter in the LPSC group (4.5 days) compared to the LAP group (12.7 days). Furthermore, LPSC was associated with lower rates of reoperation, transfusions, and postoperative anaemia. Crucially, LPSC resulted in a statistically lower occurrence of severe postoperative complications (Clavien-Dindo Grade II and III).

Conclusion. The laparoscopic approach offers clear and significant perioperative advantages over open abdominal surgery for morbidly obese patients with low-risk endometrial carcinoma. Given the improved safety profile, LPSC—or robotic-assisted surgery—should be established as the preferred initial surgical approach in these technically challenging cases.