Chalasani Venu, Martinez Carlos H, Lim Darwin, Bareeq Reem Al, Wignall Geoffrey R, Stitt Larry, Pautler Stephen E
Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, University of Western Ontario, London, ON.
Can Urol Assoc J. 2010 Aug;4(4):250-4. doi: 10.5489/cuaj.09083.
Previous studies of robotic-assisted radical prostatectomy (RARP) have suggested that obesity is a risk factor for worse perioperative outcomes. We evaluated whether body mass index (BMI) adversely affected perioperative outcomes.
A prospective database of 153 RARP (single surgeon) was analyzed. Obesity was defined as BMI >/= 30 kg/m(2); normal BMI < 25 kg/m(2); and overweight as 25 to 30 kg/m(2). Two separate analyses were performed: the first 50 cases (the initial learning curve) and the entire cohort of 153 RARP.
In the initial cohort of 50 cases (14 obese patients), there was no statistically significant difference with regards to operative times, port-placement times and estimated blood loss (EBL). Length of stay (LOS) was longer in the obese group (4.3 vs. 2.9 days); BMI remained an independent predictor of increased LOS on multivariate linear regression analysis (p = 0.002). There was no statistically significant difference in the postoperative outcomes of leak rates, margin rates and incisional herniae. In the entire cohort, when comparing obese patients to those with a normal BMI, there was no statistically significant difference in operative times, EBL, LOS, or immediate postoperative outcomes. However, on multivariate linear regression analysis, BMI was an independent predictor of increased operative time (p = 0.007).
Obese patients do not have an increased risk of blood loss, positive margins or the postoperative complications of incisional hernia and leak during the learning curve. They do, however, have slightly longer operative times; we also noted an increased LOS in our first 50 cases.
先前关于机器人辅助根治性前列腺切除术（RARP）的研究表明，肥胖是围手术期预后较差的一个危险因素。我们评估了体重指数（BMI）是否会对围手术期预后产生不利影响。
分析了一个前瞻性数据库中的153例RARP（由单一外科医生实施）。肥胖定义为BMI≥30kg/m²；正常BMI<25kg/m²；超重为25至30kg/m²。进行了两项单独的分析：前50例病例（初始学习曲线）和153例RARP的整个队列。
在最初的50例病例队列（14例肥胖患者）中，手术时间、端口放置时间和估计失血量（EBL）方面没有统计学上的显著差异。肥胖组的住院时间（LOS）更长（4.3天对2.9天）；在多变量线性回归分析中，BMI仍然是LOS增加的独立预测因素（p = 0.002）。漏率、切缘率和切口疝的术后结果没有统计学上的显著差异。在整个队列中，将肥胖患者与正常BMI患者进行比较时，手术时间、EBL、LOS或术后即刻结果没有统计学上的显著差异。然而，在多变量线性回归分析中，BMI是手术时间增加的独立预测因素（p = 0.007）。
在学习曲线期间，肥胖患者失血、切缘阳性或切口疝和漏的术后并发症风险没有增加。然而，他们的手术时间确实略长；我们还注意到在我们的前50例病例中LOS增加。
