Concomitant Metabolic Bariatric Surgery and Minimally Invasive Hysterectomy for Endometrial Cancer or Endometrial Intraepitelhelial Neoplasia in Patients with Severe Obesity: A Systematic Review of Early Experience.

Severe obesity raises endometrial cancer (EC) risk and worsens outcomes. Combining metabolic bariatric surgery (MBS) with minimally invasive hysterectomy in a single encounter may streamline care. Following PRISMA 2020, we searched Scopus, Web of Science, and PubMed (final search January 2026) with a deliberately broad search strategy to identify all reports of concomitant MBS and gynecologic oncologic surgery in adult women with severe obesity and either EC or endometrial intraepithelial neoplasia (EIN). Five studies (n = 19) met eligibility. All procedures were minimally invasive. Operative time was longer than for hysterectomy alone, without increased major morbidity or hospital stay. Six-month excess weight loss ranged 42-72%; HbA1c and antihypertensive needs improved. All patients with reported follow-up were disease-free. Concomitant MBS and minimally invasive hysterectomy appears feasible in highly selected patients with severe obesity and EC or EIN. KEY POINTS: Across 5 studies and 19 patients, concomitant MBS with minimally invasive hysterectomy was feasible in highly selected patients with EC or EIN and severe obesity. Operative time is longer than for hysterectomy alone; no major perioperative complications were reported, but the cumulative sample is too small to robustly assess safety. Where reported, six-month excess weight loss ranged 42-72%, with concurrent metabolic improvement (HbA1c and antihypertensive requirements). Short-term oncologic follow-up was encouraging but limited; long-term disease-free and overall survival are not yet established. The available evidence is hypothesis-generating and should not be extrapolated beyond expert multidisciplinary centers.