Radical prostatectomy in overweight or obese men is a greater technical challenge than in thinner men. A laparoscopic or robotic-assisted laparoscopic prostatectomy (RLRP) might be easier.
In the on-line version of Urology, Dr. Mikhail and colleagues from the University of Chicago report their experience with RLRP in overweight and obese patients. They found increased weight did not increase perioperative or postoperative morbidity.
In 2003 and 2004 150 underwent RLRP and comprised the study cohort. The men were divided according to body mass index (BMI): BMI<25kg/m 2 (group 1, normal), BMI 25-30kg/m 2 (group 2, overweight), and BMI>30kg/m 2 (group 3, obese). Patients were prospectively evaluated by administration of the validated RAND-36 Item Health Survey and the UCLA Prostate Cancer Index. Average follow-up was 8 months, and seven patients requiring open conversion were excluded from follow-up analysis.
The rate of open conversion, duration of hospitalization, positive surgical margin rate, and complication rates were not statistically different between normal and overweight or obese men. Compared to group 1, group 3 had statistically increased operative time and estimated blood loss. Group 2 had the highest transfusion rate, statistically increased compared to group 1. Prostate size was greater in overweight and obese patients.
Complications occurred in 8%, 19%, and 14% of group 1, 2, and 3 patients, respectively. Positive surgical margin rates for groups 1, 2, and 3 were 13.5%, 27%, and 17%, respectively and not statistically different. Subjectively, obese men had the best continence rates until 12 months, and then normal BMI patients had the best continence rates. Similarly, overweight men had the best return of baseline sexual function rates until 12 months, and then normal BMI patients had the best outcomes.
The first three open conversions were in obese men due to bleeding, slow progression and to obtain a better bladder neck margin. It is not stated in which group the other 4 open conversions took place.
This report suggests that RLRP had comparable outcomes in overweight and obese men, compare to those with a BMI <25kg/m 2. RLRP in patients with a BMI >25kg/m 2 is often facilitated using longer ports and instruments, such as those used in bariatric surgeries.
By Christopher P. Evans, MD
Reference: Urol 2006; 67:774-9
Mikhail AA, Stockton BR, Orvieto MA, Chien GW, Gong EM, Zorn KC, Brendler CB, Zagaja GP, Shalhav AL
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