Surgical management features of endometrial cancer in a patient with super obesity and complex abdominal history: a case report
Svintsitskyi V.S., Iegorov M.Yu., Taran L.M., Stepanenko Ye.S.
Summary. Minimally invasive surgery is the gold standard for staging early-stage endometrial cancer (EC). However, super obesity (body mass index (BMI) ≥50 m²) combined with severe pelvic adhesions and mesh-reinforced abdominal walls presents significant anesthetic and technical challenges. This paper presents a clinical case of EC in a 63-year-old patient with a BMI of 52.0 kg/m², type II diabetes mellitus, and a history of repeated ventral hernia mesh repairs with small bowel resection. Preoperatively, low-grade endometrioid adenocarcinoma with intermediate risk profile (MMRd, POLEwt, p53wt) was diagnosed. Due to high laparoscopic risks, a multidisciplinary team selected vaginal hysterectomy. Owing to the threat of intraoperative uttering fragmentation at the detachment stage, an immediate conversion to Pfannenstiel laparotomy was performed. Thorough adhesiolysis and total abdominal hysterectomy with bilateral salpingo-oophorectomy were achieved. Final histopathology revealed a tumor focus in the right ovary, re-staging the disease to FIGO 2023 Stage IIIA1 (pT3a LV1 Pn0), high-risk group. Late postoperative wound healing occurred by secondary intention, which is pathophysiologically expected in extreme obesity. This case highlights the necessity of surgical flexibility, oncological safety, and individualized decision-making.
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