EAU 2018: Obese Patients Undergoing Robotic Radical Prostatectomy Have No Impaired Operative Outcome

Copenhagen, Denmark (UroToday.com) Outcome of obese patients after robotic assisted radical prostatectomy (RARP) is still controversially discussed. The authors evaluated the impact of obesity on operative- and perioperative outcome. In this study, obesity was defined as a Body Mass Index (BMI) of over 30.

A total of 507 robotic-assisted radical prostatectomies (RARP) performed in a single robotic center from September 2009 to December 2014 were analyzed retrospectively. There were 97/507 (19%) obese patients with a median age of 65.7 years compared to 410/507 (81%) men with a BMI lower than 30, aged 66.0 years. Early postoperative complications (within 30 days after surgery) were classified using the Clavien-Dindo grading system. 

There were no significant differences in age (p=0.64), preoperative PSA value (p=0.75), pre-existing erectile dysfunction (p=0.41), intraoperative complications (n= 2 vs. 8, p=0.1) or length of hospital stay (median for both groups 8 days, p=0.69) between the two groups. Non-parametrical analysis showed a longer operation time (median 200 vs. 180 minutes, p=0.001) in obese patients and a higher blood loss (median 300 ml vs. 200 ml, p=0.005). Only in 4 non- obese patients blood transfusions were given, all of them after surgery. High BMI had no significant impact on pT staging (p=0.64), anastomotic leakage (p=0.81), lymphoceles (p=0.58) or admission to intensive care unit (p=0.27). There was no significance in unplanned readmission within 30 days after surgery (14.3% vs. 8.0%, p=0.11). 

However, significantly more urinary tract infections in patients with BMI over 30 were noted (20.4% vs. 9.2%, p=0.002). Diabetes showed a significant association with BMI over 30 (p= <0.001) but not with UTI (p=1). Early complications using the Clavien-Dindo-Grading system did not differ between the groups. The independence of urinary tract infections, higher blood loss and operative time from other parameters was confirmed in a multivariable logistic regression analysis.

These data suggest that obese patients with a BMI of over 30, who are undergoing RARP, have no impaired operative outcome. Obese patients have no overall increase of severity and amount of complications based on the Clavien-Dindo grading system, except for urinary tract infections.


Presented by: Neuenschwander J, Kantonsspital Winterthur, Dept. of Urology, Winterthur, Switzerland

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark