Comparison of complications between laparoscopic and open abdominal approaches in morbidly obese patients with early-stage endometrial carcinoma

Ajda Kljajic; Branko Cvjeticanin; Borut Kobal; Matija Barbic; Spela Smrkolj; Ivan Verdenik; Mija Blaganje

doi:10.2478/raon-2026-0021

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Comparison of complications between laparoscopic and open abdominal approaches in morbidly obese patients with early-stage endometrial carcinoma

Radiology and Oncology

Volume 60 (2026): Issue 2 (June 2026)

By: Ajda Kljajic, Branko Cvjeticanin, Borut Kobal, Matija Barbic, Spela Smrkolj, Ivan Verdenik and Mija Blaganje

Open Access

|Apr 2026

Abstract

Background

Endometrial carcinoma is the most common gynecological malignancy globally. Its rising incidence is closely linked to the increasing prevalence of morbid obesity (body mass index [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 anemia. Crucially, LPSC resulted in a statistically lower occurrence of severe postoperative complications (Clavien-Dindo Grade II and III).

Conclusions

he 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.

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Articles in this issue

DOI: https://doi.org/10.2478/raon-2026-0021 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 301 - 306

Submitted on: Nov 4, 2025

Accepted on: Feb 10, 2026

Published on: Apr 16, 2026

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Keywords:

endometrial carcinoma,

morbid obesity,

laparoscopic hysterectomy,

surgical outcomes,

Clavien-Dindo Classification

Related subjects:

Medicine,

Clinical medicine,

Radiology

© 2026 Ajda Kljajic, Branko Cvjeticanin, Borut Kobal, Matija Barbic, Spela Smrkolj, Ivan Verdenik, Mija Blaganje, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 60 (2026): Issue 2 (June 2026)