Impact of Obesity on Surgical Outcomes following Open Radical Prostatectomy

Roermund, Joep G. H. van; Basten, Jean‐Paul A. van; Kiemeney, Lambertus A.; Karthaus, H. F. M.; Witjes, J. Alfred

doi:10.1159/000209353

Cited by 36 publications

(18 citation statements)

References 57 publications

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“…19-21 To our knowledge no studies have considered the joint effects of obesity and physical inactivity on postoperative outcomes in prostate cancer survivors. Studies in men without diagnosed prostate cancer indicate that lower BMI and higher physical activity levels are associated with reduced rates of urinary incontinence,22-26 but not all studies have found an association 27.…”

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confidence: 99%

Risk of Urinary Incontinence Following Prostatectomy: The Role of Physical Activity and Obesity

et al. 2010

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Purpose Urinary incontinence is one of the most commonly reported and distressing side effects of radical prostatectomy for prostate carcinoma. Several studies have suggested that symptoms may be worse in obese men but to our knowledge no research has addressed the joint effects of obesity and a sedentary lifestyle. We evaluated the association of obesity and lack of physical activity with urinary incontinence in a sample of men who had undergone radical prostatectomy. Materials and Methods Height and weight were abstracted from charts, and obesity was defined as body mass index 30 kg/m2 or greater. Men completed a questionnaire before surgery that included self-report of vigorous physical activity. Men who reported 1 hour or more per week of vigorous activities were considered physically active. Men reported their incontinence to the surgeon at their urology visits. Information on incontinence was abstracted from charts at 6 and 58 weeks after surgery. Results At 6 weeks after surgery 59% (405) of men were incontinent, defined as any pad use. At 58 weeks after surgery 22% (165) of men were incontinent. At 58 weeks incontinence was more prevalent in men who were obese and physically inactive (59% incontinent). Physical activity may offset some of the negative consequences of being obese because the prevalence of incontinence at 58 weeks was similar in the obese and active (25% incontinent), and nonbese and inactive (24% incontinent) men. The best outcomes were in men who were nonobese and physically active (16% incontinent). Men who were not obese and were active were 26% less likely to be incontinent than men who were obese and inactive (RR 0.74, 95% CI 0.52–1.06). Conclusions Pre-prostatectomy physical activity and obesity may be important factors in post-prostatectomy continence levels. Interventions aimed at increasing physical activity and decreasing weight in patients with prostate cancer may improve quality of life by offsetting the negative side effects of treatment.

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confidence: 99%

Risk of Urinary Incontinence Following Prostatectomy: The Role of Physical Activity and Obesity

et al. 2010

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“…Interestingly, two recent studies found a higher risk of vesico-urethral strictures in obese men undergoing RP. 35,36 Although not specifically studied in the present series, where our perioperative complication rates were not appreciably different between groups, this again points to technical considerations and is worthy of further study.…”

Section: Discussionmentioning

confidence: 60%

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

et al. 2010

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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.

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“…Roermund et al [23] recently reported that obese men developed more wound infections, long-term incontinence and vesico-urethral strictures than men who were not obese. However, no consistent relationship between obesity and postoperative complications was found by others [24,25].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic radical prostatectomy is feasible and effective in ‘fit’ senior men with localized prostate cancer

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4OBJECTIVE To assess the effect of age and comorbidity on short‐term complications, long‐term continence and oncological outcome after laparoscopic radical prostatectomy (LRP) for localized prostate cancer.PATIENTS AND METHODS In all, 2048 consecutive men underwent LRP for localized prostate cancer in one institution. Comorbidity was assessed using the Charlson index. Short‐term postoperative complications, transfusion rate, duration of hospital stay, long‐term continence and oncological outcome were analysed by age and comorbidity classes.RESULTS Of the 2048 men, 297 were aged ≥70 years and 281 had a Charlson index of >0 (mainly diabetes 31%, chronic pulmonary disease 26%, prior other nonmetastatic cancer 16%, prior myocardial infarction 12%). Compared with younger men, senior men had significantly higher pathological stages and tumor grades. Of those 297 men aged ≥70 years, 90 (30.3%) developed biochemical relapse, none died from prostate cancer and five (1.7%) died from another cause over a median follow‐up of 5 years. The occurrence and severity of short‐term postoperative complications were more strongly related to comorbidity than chronological age. Multivariate analysis with stepwise regression confirmed that most important predictors of short‐term postoperative complications were a Charlson index of ≥2, prostate weight of >80 g, obesity and age of ≥70 years. Postoperative continence significantly declined with age (ranging from 87% in men aged <60 years to 67.5% in men aged ≥70 years). Predictors of long‐term incontinence were age of ≥70 years, obesity and need for perioperative transfusion.CONCLUSIONS LRP is feasible and effective in fit senior men (aged ≥70 years) with localized prostate cancer, including those at high risk of dying from it.

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Impact of Obesity on Surgical Outcomes following Open Radical Prostatectomy

Cited by 36 publications

References 57 publications

Risk of Urinary Incontinence Following Prostatectomy: The Role of Physical Activity and Obesity

Risk of Urinary Incontinence Following Prostatectomy: The Role of Physical Activity and Obesity

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

Laparoscopic radical prostatectomy is feasible and effective in ‘fit’ senior men with localized prostate cancer

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