Korean J Urol.  2012 Aug;53(8):536-540.

Advantages of Robot-Assisted Laparoscopic Radical Prostatectomy in Obese Patients: Comparison with the Open Procedure

• Bae JJ
• Choi SH
• Kwon TG
• Kim TH

Abstract

PURPOSE
Obesity has been suggested as a risk factor for worse perioperative outcomes, especially in radical prostatectomy, in several studies. However, the impact of obesity on perioperative outcomes has not yet been well elucidated for robot-assisted laparoscopic radical prostatectomy (RALP). We evaluated whether obesity had an adverse effect on outcomes following RALP compared with retropubic radical prostatectomy (RRP).
MATERIALS AND METHODS
From April 2008 to May 2011, 181 patients underwent radical prostatectomy (RALP, 111; RRP, 70). These patients were subdivided into two groups according to body mass index (BMI): the nonobese group (BMI, 25 kg/m2 or less) and the obese group (BMI, greater than 25 kg/m2). Perioperative outcomes in RALP and RRP were retrospectively compared between the two groups.
RESULTS
In RRP, patients in the obese group (n=20) showed greater blood loss and a higher complication rate than did those in the nonobese group (n=50). However, in RALP, no statistically significant differences in perioperative outcomes were observed between the obese (n=37) and the nonobese (n=74) groups. RALP showed less blood loss and a lower complication rate in both the obese and nonobese groups than did RRP.
CONCLUSIONS
RALP is thought to be a more effective and safer procedure in obese patients compared with traditional open radical prostatectomy. In the management of obese patients with localized prostate cancer, RALP should be considered as a primary choice for treatment.

Keyword

Obesity; Prostatectomy; Robotics

MeSH Terms

Body Mass Index
Humans
Obesity
Prostatectomy
Prostatic Neoplasms
Retrospective Studies
Risk Factors
Robotics

Reference

1. Kopelman PG. Obesity as a medical problem. Nature. 2000. 404:635–643.

2. Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol. 1994. 170:560–565.

3. Pitkin RM. Vaginal hysterectomy in obese women. Obstet Gynecol. 1977. 49:567–569.

4. Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, et al. EAU guidelines on prostate cancer. Eur Urol. 2008. 53:68–80.

5. Chang SS, Duong DT, Wells N, Cole EE, Smith JA Jr, Cookson MS. Predicting blood loss and transfusion requirements during radical prostatectomy: the significant negative impact of increasing body mass index. J Urol. 2004. 171:1861–1865.

6. Chang IH, Byun SS, Hong SK, Lee SE. Assessing the body mass index of patients might help to predict blood loss during radical retropubic prostatectomy in Korean men. BJU Int. 2007. 99:570–574.

7. Komaru A, Kamiya N, Suzuki H, Endo T, Takano M, Yano M, et al. Implications of body mass index in Japanese patients with prostate cancer who had undergone radical prostatectomy. Jpn J Clin Oncol. 2010. 40:353–359.

8. Lloyd JC, Banez LL, Aronson WJ, Terris MK, Presti JC Jr, Amling CL, et al. Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database. Prostate Cancer Prostatic Dis. 2009. 12:264–268.

9. Kaul S, Menon M. Robotic radical prostatectomy: evolution from conventional to VIP. World J Urol. 2006. 24:152–160.

10. Ahlering TE, Eichel L, Edwards RA, Lee DI, Skarecky DW. Robotic radical prostatectomy: a technique to reduce pT2 positive margins. Urology. 2004. 64:1224–1228.

11. Tewari A, Kaul S, Menon M. Robotic radical prostatectomy: a minimally invasive therapy for prostate cancer. Curr Urol Rep. 2005. 6:45–48.

12. Ham WS, Park SY, Cho KS, Lee JS, Choi YD. Comparison of open and robotic surgery in radical prostatectomy: a single surgeon's experience. Korean J Urol. 2008. 49:221–226.

13. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009. 55:1037–1063.

14. Mikhail AA, Stockton BR, Orvieto MA, Chien GW, Gong EM, Zorn KC, et al. Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology. 2006. 67:774–779.

15. Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology. 2005. 65:740–744.

16. Khaira HS, Bruyere F, O'Malley PJ, Peters JS, Costello AJ. Does obesity influence the operative course or complications of robot-assisted laparoscopic prostatectomy. BJU Int. 2006. 98:1275–1278.

17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004. 240:205–213.

18. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004. 363:157–163.

19. Menon M, Tewari A, Peabody J. VIP Team. Vattikuti Institute prostatectomy: technique. J Urol. 2003. 169:2289–2292.

20. Jeong W, Araki M, Park SY, Lee YH, Kumon H, Hong SJ, et al. Robot-assisted laparoscopic radical prostatectomy in the Asian population: modified port configuration and ultradissection. Int J Urol. 2010. 17:297–300.

21. Park HS, Park CY, Oh SW, Yoo HJ. Prevalence of obesity and metabolic syndrome in Korean adults. Obes Rev. 2008. 9:104–107.

22. Korean National Statistical Office 2005. Report of statistics in mortality in Korean. 2006. Seoul: Korean National Statistical Office.

23. Lee SY, Park SJ, Jang IH, Myung SC, Kim TH. The effects of adiponectin and leptin in the proliferation of prostate cancer cells. Korean J Urol. 2009. 50:493–497.

24. Freedland SJ, Wen J, Wuerstle M, Shah A, Lai D, Moalej B, et al. Obesity is a significant risk factor for prostate cancer at the time of biopsy. Urology. 2008. 72:1102–1105.

25. Freedland SJ, Banez LL, Sun LL, Fitzsimons NJ, Moul JW. Obese men have higher-grade and larger tumors: an analysis of the duke prostate center database. Prostate Cancer Prostatic Dis. 2009. 12:259–263.

26. Freedland SJ, Terris MK, Platz EA, Presti JC Jr. Body mass index as a predictor of prostate cancer: development versus detection on biopsy. Urology. 2005. 66:108–113.

27. Castle EP, Atug F, Woods M, Thomas R, Davis R. Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol. 2008. 26:91–95.

28. Bhayani SB, Pavlovich CP, Strup SE, Dahl DM, Landman J, Fabrizio MD, et al. Laparoscopic radical prostatectomy: a multi-institutional study of conversion to open surgery. Urology. 2004. 63:99–102.

29. Freedland SJ, Grubb KA, Yiu SK, Nielsen ME, Mangold LA, Isaacs WB, et al. Obesity and capsular incision at the time of open retropubic radical prostatectomy. J Urol. 2005. 174:1798–1801.

30. Freedland SJ, Grubb KA, Yiu SK, Humphreys EB, Nielsen ME, Mangold LA, et al. Obesity and risk of biochemical progression following radical prostatectomy at a tertiary care referral center. J Urol. 2005. 174:919–922.