Laparoscopic and robotic radical prostatectomy outcomes in obese and extremely obese men

Debasish Sundi, Adam C. Reese, Lynda Z. Mettee, Bruce Trock, Christian Pavlovich

Research output: Contribution to journalArticle

Abstract

Objective To evaluate the operative and pathologic outcomes of laparoscopic radical prostatectomy and robot-assisted radical prostatectomy in men with progressive changes in body mass index (BMI) category. Materials and methods A single-surgeon series of 1023 laparoscopic radical prostatectomy and robot-assisted radical prostatectomy (mostly extraperitoneal) patients was considered. Of these patients, 987 were evaluable. Results were stratified by the World Health Organization BMI category. Multivariate linear and logistic regression analysis was used to model the operating time, length of stay, positive surgical margins, and noncurable cancer. Results Of the 987 patients, 563 (57%) were overweight and 193 (19.6%) were obese. Of the 193 obese patients, 152 (15.4%) had a BMI of 30 to 2 (class I obesity), 28 (2.8%) a BMI of 35 to 2 (class II), and 13 (1.3%) a BMI of ≥40 kg/m2 (class III). No differences were found in the estimated blood loss, complications, PSM, pathologic stage, or biochemical recurrence across the BMI categories (6-month median follow-up). However, pelvic lymph node dissection was more commonly omitted and the nerve-sparing score was inferior in the obese men. On multivariate analysis, a higher BMI was a significant predictor of a longer operating time. Conclusion Obese men can safely undergo laparoscopic radical prostatectomy or robot-assisted radical prostatectomy, although the ability to perform excellent nerve sparing appears to decrease with increasing obesity. Nevertheless, obese men can expect perioperative and early oncologic outcomes comparable to those of normal weight men without an increased risk of perioperative complications.

Original languageEnglish (US)
Pages (from-to)600-605
Number of pages6
JournalUrology
Volume82
Issue number3
DOIs
StatePublished - Sep 2013

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Robotics
Prostatectomy
Body Mass Index
Obesity
Lymph Node Excision
Linear Models
Length of Stay
Multivariate Analysis
Logistic Models
Regression Analysis
Weights and Measures
Recurrence
Neoplasms

ASJC Scopus subject areas

  • Urology

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Laparoscopic and robotic radical prostatectomy outcomes in obese and extremely obese men. / Sundi, Debasish; Reese, Adam C.; Mettee, Lynda Z.; Trock, Bruce; Pavlovich, Christian.

In: Urology, Vol. 82, No. 3, 09.2013, p. 600-605.

Research output: Contribution to journalArticle

Sundi, Debasish ; Reese, Adam C. ; Mettee, Lynda Z. ; Trock, Bruce ; Pavlovich, Christian. / Laparoscopic and robotic radical prostatectomy outcomes in obese and extremely obese men. In: Urology. 2013 ; Vol. 82, No. 3. pp. 600-605.
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abstract = "Objective To evaluate the operative and pathologic outcomes of laparoscopic radical prostatectomy and robot-assisted radical prostatectomy in men with progressive changes in body mass index (BMI) category. Materials and methods A single-surgeon series of 1023 laparoscopic radical prostatectomy and robot-assisted radical prostatectomy (mostly extraperitoneal) patients was considered. Of these patients, 987 were evaluable. Results were stratified by the World Health Organization BMI category. Multivariate linear and logistic regression analysis was used to model the operating time, length of stay, positive surgical margins, and noncurable cancer. Results Of the 987 patients, 563 (57{\%}) were overweight and 193 (19.6{\%}) were obese. Of the 193 obese patients, 152 (15.4{\%}) had a BMI of 30 to 2 (class I obesity), 28 (2.8{\%}) a BMI of 35 to 2 (class II), and 13 (1.3{\%}) a BMI of ≥40 kg/m2 (class III). No differences were found in the estimated blood loss, complications, PSM, pathologic stage, or biochemical recurrence across the BMI categories (6-month median follow-up). However, pelvic lymph node dissection was more commonly omitted and the nerve-sparing score was inferior in the obese men. On multivariate analysis, a higher BMI was a significant predictor of a longer operating time. Conclusion Obese men can safely undergo laparoscopic radical prostatectomy or robot-assisted radical prostatectomy, although the ability to perform excellent nerve sparing appears to decrease with increasing obesity. Nevertheless, obese men can expect perioperative and early oncologic outcomes comparable to those of normal weight men without an increased risk of perioperative complications.",
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