Moskovic Daniel J, Lavery Hugh J, Rehman Jamil, Nabizada-Pace Fatima, Brajtbord Jonathan, Samadi David B
Department of Urology, Mount Sinai School of Medicine, New York, New York 10029, USA.
Can J Urol. 2010 Aug;17(4):5291-8.
Given the anatomic constraints of obese patients, concern exists as to whether robotic assisted laparoscopic prostatectomy (RALP) is appropriate in patients with higher body mass index (BMI). We reviewed a large RALP database to determine if clinical outcomes are related to BMI.
The records of patients who underwent a RALP from 2003-2009 were reviewed. BMI stratifications were concordant with the Centers for Disease Control (CDC) standards: > or = 30, > or = 25 and < 30, and < 25 were classified as obese, overweight, and normal weight, respectively. Baseline, perioperative, histopathologic, and functional outcome data were collected.
A total of 1420 patients were identified and BMI information was available for 1112 patients. Median BMI in the three strata was 23.5 (n = 270), 27.3 (n = 600), and 32.1 (n = 242). There were no significant differences in preoperative prostate specific antigen (PSA), clinical staging, and preoperative Gleason scores. Operating time was 6 minutes longer in the obese (p < 0.001) and prostate weight was 8 g greater (p < 0.001). Other perioperative factors were similar, including: EBL, pathologic stage and Gleason score and rates of positive surgical margins. The overall incidence of postoperative complications was similar between the three groups. Biochemical recurrence rates were similar among all patients, although there was a trend toward increased recurrence in the obese (p = 0.09). Recovery of erectile function and continence was similar regardless of BMI.
RALP is an effective approach to prostatectomy in obese patients as perioperative and functional outcomes are almost identical across BMI strata. This supports the continued utilization of RALP in obese and overweight men.
鉴于肥胖患者的解剖学限制，对于体重指数（BMI）较高的患者，机器人辅助腹腔镜前列腺切除术（RALP）是否合适存在疑虑。我们回顾了一个大型RALP数据库，以确定临床结果是否与BMI相关。
回顾了2003年至2009年接受RALP手术的患者记录。BMI分层与疾病控制中心（CDC）标准一致：≥30、≥25且<30以及<25分别被归类为肥胖、超重和正常体重。收集了基线、围手术期、组织病理学和功能结局数据。
共确定了1420例患者，其中1112例患者有BMI信息。三个分层中的BMI中位数分别为23.5（n = 270）、27.3（n = 600）和32.1（n = 242）。术前前列腺特异性抗原（PSA）、临床分期和术前Gleason评分无显著差异。肥胖患者的手术时间长6分钟（p < 0.001），前列腺重量重8克（p < 0.001）。其他围手术期因素相似，包括：估计失血量、病理分期和Gleason评分以及手术切缘阳性率。三组术后并发症的总体发生率相似。所有患者的生化复发率相似，尽管肥胖患者有复发增加的趋势（p = 0.09）。无论BMI如何，勃起功能和控尿功能的恢复相似。
RALP是肥胖患者前列腺切除术的有效方法，因为不同BMI分层的围手术期和功能结局几乎相同。这支持在肥胖和超重男性中继续使用RALP。
