Can robotic assisted laparoscopic prostatectomy be recommended to obese patients?

Abstract

Experienced robotic surgeons report lower estimated blood loss (EBL) and transfusion rates with similar clinical outcomes for robotic assisted laparoscopic radical prostatectomy (RALP) compared to open radical retropubic prostatectomy (RRP). We reviewed our experience with RALP to investigate how to counsel overweight and obese patients being considered for RALP regarding risk of major perioperative complications, oncological outcomes, and short-term recovery. We reviewed the data on 1,513 patients who underwent RALP by one of four experienced robotic surgeons between June 2003 and November 2006. These patients were categorized as normal, overweight, obese, and severely obese based on body mass index (BMI). Of these patients, 361 (23.9%) had a BMI under 25, 794 (52.5%) had a BMI between 25 and 30 (overweight), 290 (19.2%) had a BMI between 30 and 35 (obese), and 68 (4.5%) had a BMI over 35 (severely obese). Records were examined and analyzed with respect to BMI for major intra- and perioperative complications, operative time, margin status, EBL, transfusion rates, and length of hospital stay. Increasing BMI was associated with longer operative time, with mean operative times of 2.7, 2.8, 3.1, and 3.3 h for normal, overweight, obese and severely obese patients, respectively (P < 0.0001). Higher blood loss, though not clinically significant, was also associated with increased BMI, with obese and severely obese patients losing a median of 250 mL of blood compared to 200 mL in overweight and non-overweight patients (P < 0.0001). Transfusion rates, intra- and perioperative complications, margin status, and length of stay were not found to be associated with BMI group. Robotic assisted laparoscopic radical prostatectomy in experienced hands can be safely recommended to eligible patients regardless of BMI status.

Obese men undergoing radical prostatectomy: Is robotic or retropubic better to limit positive surgical margins? Results from SEARCH

“…Although the link between obesity and aggressive disease, and thereby PSM, should apply to RALP too, it is less clear whether obesity is a risk factor for PSMs in RALP. Most prior studies found no link, although these studies were limited by small sample sizes 20 . Consistent with prior studies, we also found no association between obesity and PSMs in RALP, suggesting the potential advantages of the robotic technique might be technically favorable for obese men.…”

Outcomes of Extraperitoneal Robot-Assisted Radical Prostatectomy in the Morbidly Obese: A Propensity Score-Matched Study

“…There was no difference in lymph node yield. The median (range) number of lymph nodes was 5 (2-21) and 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) in the 2 groups (BMI > 40 kg/m 2 , and BMI < 40 kg/m 2 ) respectively. While the morbidly obese had a higher rate of harboring more aggressive disease on final pathology than the non-morbidly obese group (pT3 rates 27.5% vs. 7.5 % respectively, p=0.04), there were no significant differences in other postoperative…”

PC-PEP, a Comprehensive Daily Six-Month Home-Based Patient Empowerment Program Leads to Weight Loss in Men with Prostate Cancer: A Secondary Analysis of a Clinical Trial

“…The correlation between higher BMI and increased aggressiveness of tumours, as well as the heightened risk of biochemical recurrence following radical prostatectomy (RP), has been well documented [ 27 ]. Furthermore, obesity poses additional challenges during RP, particularly in surgeries utilizing robotic assistance, potentially impacting oncological outcomes by increasing the complexity of the procedure, extending operative times, and elevating the likelihood of converting to open surgery [ 28 ]. Given that over 70% of men eligible for RP fall into the overweight or obese categories, this presents a significant concern for surgical management and outcome optimization [ 27 , 28 , 29 ].…”