Introduction: An increasing number of obese patients (BMI >30 kg/m2) with localized prostate cancer are presenting as candidates for RARP, which can be carried out using the transperitoneal (TP) or the extraperitoneal (EP) approach.
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Morbidly obese (BMI > 40 kg/m2) patients present as an especially challenging surgical cohort. We sought to evaluate the perioperative and pathological outcomes associated with EP-RARP in morbidly obese men.
Methods: In this institutional review board approved study, our prospectively collected database (CAISIS) was reviewed. 1663 patients underwent EP-RARP for localized prostate cancer at our institution between July 2003 and December 2013, by a single surgeon. 40 patients were considered morbidly obese. A propensity score-matched analysis was performed using multivariate analysis incorporating 10 co-variates to identify comparable group of patients with a BMI of >40 kg/m2 and < 40 kg/m2.
Results: Apart from BMI, the two groups were matched (all p-values >0.05). Despite a higher total operating time and estimated blood loss in the morbidly obese (238 vs 176 mins, p < 0.0001, and 235 vs 192 ccs, p=0.003 respectively), there were no differences in the ability to perform nerve-sparing or pelvic lymphadenectomy, or the length of stay. While the morbidly obese had a higher rate of harboring more aggressive disease on final pathology (pT3 rates 27.5 vs 7.5 % respectively), there were no differences in other postoperative pathological parameters such as prostate specimen weight, positive surgical margin status, and Gleason score sum. Moreover, there were no differences in intra- or postoperative complications between the two groups.
Conclusion: The morbidly obese cohort harbored more aggressive disease with the difference in the proportion of pathological T3 disease statistically significant. Apart from increased total operating time and estimated blood loss, EP-RARP leads to comparable perioperative and pathological outcomes to the non-morbidly obese. Consideration should be given to added operating room time when operating on the morbidly obese.
Agrawal V, Feng C, Joseph JV. Are you the author?
University of Rochester Medical Center, Urology, Rochester, New York, United States.
Reference: J Endourol. 2014 Oct 27. Epub ahead of print.