Increasing Body Mass Index Negatively Impacts Outcomes Following Robotic Radical Prostatectomy

Department of Urology, The New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons (Impact Factor: 0.91). 10/2007; 11(4):438-42.
Source: PubMed

ABSTRACT To clarify the impact of increasing body mass index (BMI) on outcomes following robotic radical prostatectomy.
From January 2003 to May 2005, 132 patients with clinically localized prostate cancer underwent a robotic radical prostatectomy. Patients were divided into 3 cohorts based on BMI: 38 normal (range, 18 to 24.9), 60 overweight (range, 25 to 29.9), and 34 obese (BMI>30).
The operative time was significantly longer in obese (304 min) men compared with overweight (235 min) and normal (238 min) BMI patients (P<0.001). Estimated blood loss was significantly greater in both the obese (316 mL) and overweight (318 mL) groups compared with men with normal BMI (234 mL) (P<0.005). Three patients (1 obese and 2 overweight) required conversion to open surgery. Twenty-three of 132 men (17%) had a positive surgical margin, with obese (21%) and overweight (20%) men at a greater risk compared with normal BMI men (11%). No significant differences existed between groups with regard to final pathologic stage, Gleason score, biochemical recurrence at 1-year, and postoperative complication rate.
Overweight and obese men had a longer operative duration, greater blood loss, longer hospital duration, and higher positive surgical margin rate. Robotic prostatectomy in men with elevated BMI is technically more challenging and is associated with more operative morbidity.

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    • "Herman et al analysed a group of 132 men undergoing RALP, including 60 overweight and 34 obese patients with matched disease characteristics [10]. The overweight and obese patients had a longer operative duration (304 min vs 235 min; p < 0.001), greater blood loss, longer hospital stay, and higher positive surgical margin (PSM) rates (21% vs 11%; p = 0.18). "
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    ABSTRACT: Although the popularity of robotic-assisted laparoscopic prostatectomy is assured, little is known about the oncologic outcomes following the procedure. We performed a retrospective cohort study including consecutive patients who underwent the surgery between 2003 and 2007 with at least 6 months of follow-up (n=464). Patients were stratified into low-, intermediate-, and high-risk groups according to D'Amico criteria. Biochemical failure was defined as a PSA > or =0.2 ng/mL. Of study patients, 256 (55%), 171 (37%), and 37 (8%) were classified as low-, intermediate-, and high-risk, respectively. Over a mean follow-up of 14.1 months (range, 6.0 to 55.3), 7.3% experienced biochemical failure. Biochemical disease-free survival at 30 months was 94%, 79%, and 73% among patients in the low-, intermediate-, and high-risk groups, respectively, (P<0.001). Preoperative risk stratification was strongly associated with biochemical failure, with hazard ratios of 5.04 (95%: 1.52 to 16.7; P<0.001) and 7.04 (95%: 1.39 to 35.6; P < 0.001) for intermediate- and high- over low-risk groups, respectively. The ability of risk stratification to predict biochemical failure had an area under the receiver operator characteristic curve of 0.74. Robotic prostatectomy provides excellent cancer control outcomes for clinically localized disease.
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