Comparison of Surgical Outcomes Among Open, Laparoscopic, and Robotic Surgeries in Women with Obesity Diagnosed with Endometrial Cancer: Results from a Quaternary Hospital in Thailand.

Purpose: We compared the surgical outcomes of robotic surgery (RS), laparoscopic surgery (LS), and open surgery (OS) in Asian women with obesity diagnosed with endometrial cancer. Patients and Methods: In this retrospective cohort study, the data of 248 patients with a body mass index (BMI) of ≥25 kg/m Results: Compared with the OS and LS groups, the RS group had a significantly higher median BMI and higher rates of obstructive sleep apnea, yet demonstrated superior perioperative outcomes. Sentinel lymph node dissection was performed predominantly in the RS group, whereas systemic lymphadenectomy was more commonly undertaken in the OS and LS groups. However, after adjusting for the type of lymphadenectomy, no significant effect on estimated blood loss (EBL) was observed. RS was associated with the lowest EBL, no transfusion requirements, and significantly reduced postoperative pain and opioid consumption compared with LS and OS (p < 0.001). Furthermore, RS resulted in the shortest median hospital stay (42 h) compared to LS (64 h) and OS (86 h). The overall complication rates were markedly lower in the RS group (9.4%) than in the LS (30.3%) and OS (44.2%) groups, with no high-grade complications or conversions to laparotomy observed in the robotic cases. Conclusion: These findings suggested that robotic surgery is a safe and highly effective approach for Asian women with obesity, offering reduced morbidity and accelerated recovery, despite higher baseline patient complexity.