Robotic Surgery for Sigmoid Colon Cancer in a Patient With Severe Obesity and Protocol Proposal of Preoperative Weight Reduction Program.

Surgical procedures in patients with severe obesity are associated with an increased risk of complications. Preoperative weight reduction is recommended. We report a case of robotic-assisted sigmoidectomy in a patient with severe obesity (obesity class III: WHO classification) and sigmoid colon cancer after preoperative management based on the previously reported protocol. A 47-year-old man was referred from a private clinic because of an occult fecal blood test during a routine annual check-up. The colonoscopy with pathological examination and contrast-enhanced computed tomography (CE-CT) revealed stage cT3N1bM0 sigmoid colon cancer. Since he was allowed to wait up to six weeks before colon cancer surgery to avoid intraoperative and postoperative complications, we organized the multidisciplinary team for a preoperative multidisciplinary weight reduction program (WRP) based on corrected body weight (cBW), adding physical therapy, smoking and alcohol cessation counseling, sleep apnea screening, and continuous positive airway pressure (CPAP) therapy. He successfully reduced the BW from 122 to 112 kg and underwent robotic surgery for sigmoid colon cancer with a minimal blood loss of 22 mL. Based on our current experience, we propose preoperative WRP using a concept of cBW for super-obese surgical patients whose BMI is above 40 kg/m2.