Preoperative Management with Mazindol for Obese Women Diagnosed with Endometrial Carcinoma Undergoing Robot-assisted Hysterectomy: A Pilot Case Series and Literature Review.

OBJECTIVES

Obesity poses major perioperative challenges in gynecologic malignancies, particularly endometrial cancer, and increases surgical complexity and risk. Although robot-assisted hysterectomy (RAH) and bilateral salpingo-oophorectomy are preferred for early-stage cases, the obese patients make it limit their feasibility. Preoperative weight loss may improve outcomes; however, the pharmacological options remain understudied. This study explored the feasibility of a preoperative mazindol-based weight-loss program in severely obese patients.

MATERIALS AND

METHODS

A retrospective case series study was conducted on four women (body mass index [BMI] ≥35 kg/m²) who were suspected of having stage 1A endometrial cancer based on preoperative magnetic resonance imaging between January 2021 and July 2024. The patients received nutritional counseling and mazindol (1.0 mg/day) before undergoing surgery. The effect of mazindol was indexed by each patient's weight loss before surgery, and surgery-related parameters included the time of surgery, the amount of blood loss, and the presence of surgical complications.

RESULTS

Patients experienced a median weight reduction of 13.7 kg (range, 9.1-17.4 kg), with a corresponding decrease in BMI. Operative time was 247.5 min, with a console time of 214 min and blood loss of 75 g. The Trendelenburg angle was 18°-19°, which facilitated adequate surgical visualization. No adverse effects or postoperative complications were observed.

CONCLUSION

Preoperative administration of mazindol resulted in significant weight loss, enabling safer RAH with reduced surgical complexity. This suggests that mazindol may be a viable option for weight reduction in obese patients absolutely requiring gynecologic surgery for malignant diseases.