Perioperative and early oncological outcomes after robot‐assisted radical prostatectomy (RARP) in morbidly obese patients: a propensity score‐matched study. (5th March 2013)

• Record Type: Journal Article
• Authors: Abdul‐Muhsin, Haidar; Giedelman, Camilo; Samavedi, Srinivas; Schatloff, Oscar; Coelho, Rafael; Rocco, Bernardo; Palmer, Kenneth; Ebra, George; Patel, Vipul
• Is Part Of: BJU international. Volume 113:Number 1(2014:Jan.)
• Page Start: 84
• Page End: 91
• Publication Date: 2013-03-05
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2013.11798.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11798-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju11798-list-0001" list-type="bullet"> <list-item> <p>To evaluate the perioperative and pathological outcomes associated with robot‐assisted radical prostatectomy (RARP) in morbidly obese men.</p> </list-item> </list> </p> </sec> <sec id="bju11798-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju11798-list-0002" list-type="bullet"> <list-item> <p>Between January 2008 and March 2012, 3041 patients underwent RARP at our institution by a single surgeon (V.P.).</p> </list-item> <list-item> <p>In all, 44 patients were considered morbidly obese with a body mass index (BMI) of ≥40 kg/m<sup>2</sup>.</p> </list-item> <list-item> <p>A propensity score‐matched analysis was conducted using multivariable analysis to identify comparable groups of patients with a BMI of ≥40 and <40 kg/m<sup>2</sup>.</p> </list-item> <list-item> <p>Perioperative, pathological outcomes and complications were compared between the two matched groups.</p> </list-item> </list> </p> </sec> <sec id="bju11798-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju11798-list-0003" list-type="bullet"> <list-item> <p>There was no significant difference in operative time. However, the mean estimated blood loss was higher in morbidly obese patients, at a mean (<sc>sd</sc>) of 113 (41) vs 130 (27) mL (<italic>P</italic> = 0.049).</p> </list-item> <list-item> <p>Anastomosis was more difficult in morbidly obese patients (<italic>P</italic> = 0.001).</p> </list-item> <list-item> <p>There were no significant differences in laterality, ease of nerve sparing, or transfusion rate between the groups.</p> </list-item> <list-item> <p>There were no intraoperative complications in either group. Postoperative pathological outcomes were similar between the groups.</p> </list-item> <list-item> <p>Differences in positive surgical margins and ease of nerve sparing approached statistical significance (<italic>P</italic> = 0.097, <italic>P</italic> = 0.075 respectively). Postoperative complication rates, pain scores, length of stay and indwelling catheter duration were similar in the groups.</p> </list-item> </list> </p> </sec> <sec id="bju11798-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11798-list-0004" list-type="bullet"> <list-item> <p>RARP in morbidly obese patients is technically demanding. However, it can be accomplished with acceptable morbidity and resource use.</p> </list-item> <list-item> <p>In the hands of an experienced surgeon, it is a safe procedure and offers beneficial clinical outcomes.</p> </list-item> </list> </p> </sec> </abstract>