Mikhail Albert A, Stockton Benjamin R, Orvieto Marcelo A, Chien Gary W, Gong Edward M, Zorn Kevin C, Brendler Charles B, Zagaja Gregory P, Shalhav Arieh L
Department of Surgery, University of Chicago, Chicago, Illinois 60637, USA.
Urology. 2006 Apr;67(4):774-9. doi: 10.1016/j.urology.2005.10.049. Epub 2006 Mar 29.
To assess outcomes of robotic laparoscopic radical prostatectomy (RLRP) in overweight and obese patients, defined as those with a body mass index (BMI) of 25 to 30 kg/m2 and greater than 30 kg/m2, respectively.
This was a nonrandomized study evaluating all of our RLRP patients. Patients were divided into three groups: BMI of 25 kg/m2 or less (group 1), BMI greater than 25 kg/m2 and less than 30 kg/m2 (group 2), and BMI of 30 kg/m2 or more (group 3). Patients were evaluated prospectively with the validated Rand 36-Item Health Survey (version 2) and with the University of California, Los Angeles Prostate Cancer Index questionnaire.
Between February 2003 and November 2004, 150 RLRPs were performed at our center. Average follow-up was 8 months. Groups 1, 2, and 3 had 39, 65, and 46 patients, respectively. Average BMIs for all three groups were statistically different (P < 0.01). When compared with group 1, open conversion rates, hospital stay, positive margin, and complication rates were not statistically different for groups 2 or 3. Operative time (P < 0.004) and estimated blood loss (P < 0.03), however, were statistically greater for group 3 compared with group 1. Transfusion rate was highest in group 2 (P = 0.04 compared with group 1). Prostate weights were also statistically greater in groups 2 (P = 0.003) and 3 (P = 0.02) compared with group 1. Overall, BMI did not increase perioperative and postoperative morbidity.
Robotic laparoscopic radical prostatectomy is safe in overweight and obese patients and might be the surgical management of choice in this subset of patients. Further long-term follow-up with more patients is required to verify this initial observation.
评估机器人腹腔镜根治性前列腺切除术（RLRP）应用于超重和肥胖患者（分别定义为体重指数[BMI]为25至30kg/m²以及大于30kg/m²的患者）的疗效。
这是一项评估我们所有RLRP患者的非随机研究。患者被分为三组：BMI为25kg/m² 或更低（第1组）、BMI大于25kg/m² 且小于30kg/m²（第2组）以及BMI为30kg/m² 或更高（第3组）。采用经过验证的兰德36项健康调查（第2版）和加利福尼亚大学洛杉矶分校前列腺癌指数问卷对患者进行前瞻性评估。
在2003年2月至2004年11月期间，我们中心进行了150例RLRP手术。平均随访时间为8个月。第1、2和3组分别有39、65和46例患者。所有三组的平均BMI在统计学上存在差异（P<0.01）。与第1组相比，第2组或第3组的开放手术转换率、住院时间、切缘阳性率和并发症发生率在统计学上无差异。然而，与第1组相比，第3组的手术时间（P<0.004）和估计失血量（P<0.03）在统计学上显著更高。第2组的输血率最高（与第1组相比，P = 0.04）。与第1组相比，第2组（P = 0.003）和第3组（P = 0.02）的前列腺重量在统计学上也更大。总体而言，BMI并未增加围手术期和术后发病率。
机器人腹腔镜根治性前列腺切除术在超重和肥胖患者中是安全的，可能是这类患者的手术治疗选择。需要对更多患者进行进一步的长期随访以验证这一初步观察结果。
