Boorjian Stephen A, Crispen Paul L, Carlson Rachel E, Rangel Laureano J, Karnes R Jeffrey, Frank Igor, Gettman Matthew T
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905, USA.
J Endourol. 2008 Jul;22(7):1471-6. doi: 10.1089/end.2008.0056.
To investigate the impact of body mass index (BMI) on pathologic and functional outcomes after robot-assisted laparoscopic prostatectomy (RALP).
We evaluated 400 consecutive patients who underwent RALP at the Mayo Clinic between 2002 and 2006. Patients were categorized as normal weight (BMI <25 kg/ m(2), n = 94), overweight (BMI 25-29.9 kg/m(2), n = 187), and obese (BMI >or=30 kg/m(2), n = 119). Clinicopathologic features of the groups were compared, and logistical regression analysis was used to assess the associations of BMI with pathologic and functional outcomes after RALP.
Overweight and obese patients were more likely to have pT(3/4) disease (P = 0.0024) and pathologic Gleason 7 to 10 cancers (P < 0.0001). Overall, 9/94 (9.6%) normal-weight patients had a positive surgical margin (SM), compared with 25/187 (13.4%) overweight patients and 21/119 (17.6%) obese men (P = 0.087). On multivariate analysis, however, increasing BMI was not significantly associated with an increased risk of positive SM (odds ratio 1.12, 95% confidence interval 0.72-1.76, P = 0.61). In addition, although obese men had longer operative times (P = 0.049) and greater intraoperative blood loss (P = 0.04), we found no association between BMI and transfusion requirement (P = 0.34), length of hospital stay (P = 0.54), or the rates of early (P = 0.37) or late (P = 0.86) complications. Moreover, in those patients with follow-up available at 1 year after RALP, obesity did not impact the return of continence (P = 0.62) or potency (P = 0.13).
BMI was not an independent predictor of positive SM, complications, incontinence, or erectile dysfunction after RALP. These data suggest that RALP may offer equivalent margin rates and functional outcomes for patients across BMI.
探讨体重指数（BMI）对机器人辅助腹腔镜前列腺切除术（RALP）后病理及功能结果的影响。
我们评估了2002年至2006年间在梅奥诊所连续接受RALP手术的400例患者。患者被分为正常体重（BMI<25 kg/m²，n = 94）、超重（BMI 25 - 29.9 kg/m²，n = 187）和肥胖（BMI≥30 kg/m²，n = 119）三组。比较了三组的临床病理特征，并采用逻辑回归分析评估BMI与RALP术后病理及功能结果之间的关联。
超重和肥胖患者更有可能患有pT(3/4)期疾病（P = 0.0024）以及病理Gleason评分7至10分的癌症（P < 0.0001）。总体而言，9/94（9.6%）的正常体重患者手术切缘阳性（SM），相比之下，超重患者中有25/187（13.4%），肥胖男性中有21/119（17.6%）（P = 0.087）。然而，多因素分析显示，BMI增加与SM阳性风险增加无显著关联（比值比1.12，95%置信区间0.72 - 1.76，P = 0.61）。此外，尽管肥胖男性手术时间更长（P = 0.049）且术中失血量更多（P = 0.04），但我们发现BMI与输血需求（P = 0.34）、住院时间（P = 0.54）或早期（P = 0.37）或晚期（P = 0.86）并发症发生率之间无关联。而且，在RALP术后1年有随访数据的患者中，肥胖对尿失禁恢复（P = 0.62）或性功能恢复（P = 0.13）无影响。
BMI并非RALP术后SM阳性、并发症、尿失禁或勃起功能障碍的独立预测因素。这些数据表明，RALP可能为不同BMI的患者提供相当的切缘阳性率和功能结果。
