Radical prostatectomy in obese patients: Improved surgical outcomes in recent years

Abstract

Objectives: Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP. Methods: Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were divided into three groups based on their body mass index (BMI): <25, 25-30 (overweight) and >30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores. Results: Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18-1.09), were not shown. Conclusion: As surgical experience with high BMI patients has developed , RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar.

Robot-Assisted Laparoscopic Radical Prostatectomy in the Morbidly Obese Patient

“…Open radical retropubic prostatectomy in obese patients was described by Lindner [13]. While the incidence of perioperative complications and blood transfusions was similar, the authors found that EBL was higher in the obese group and operative times in the obese were longer.…”

Obesity and cancer treatment efficacy: Existing challenges and opportunities

“…Even minor surgical complications, such as wound infections and lymphedema, can result in increased cost, reduced quality of life for patients, and delays in the receipt of adjuvant therapy, such as chemotherapy and radiation. Among patients with prostate cancer, 1 study demonstrated that surgical time was prolonged and blood loss was greater in obese patients, although these factors did not translate into higher transfusion rates . Another study reported that obesity was associated with an increased risk of having positive surgical margins after radical prostatectomy, which, in turn, are associated with an increased risk of recurrence, poor outcomes, and a potential need for additional adjuvant treatment …”

“…Among patients with prostate cancer, 1 study demonstrated that surgical time was prolonged and blood loss was greater in obese patients, although these factors did not translate into higher transfusion rates. 13 Another study reported that obesity was associated with an increased risk of having positive surgical margins after radical prostatectomy, 14 which, in turn, are associated with an increased risk of recurrence, poor outcomes, and a potential need for additional adjuvant treatment. 15 OBESITY AND RADIATION THERAPY Radiation therapy uses targeted ionizing radiation to destroy tumor cells.…”

Association Between Various Indices of Obesity and Intraoperative Factors in Laparoscopic Donor Nephrectomy

“…[8][9][10] Several studies have reported a correlation between operating time or blood loss and BMI in laparoscopic nephrectomy. [11][12][13] Transperitoneal laparoscopic renal surgery for obese patients with a BMI of 30 kg/m 2 or greater had longer operative times and increased blood loss compared with the same procedure in non-obese patients.…”