Institut National de la Sante et de la Recherche Medicale Unit 955 EQ7, Department of Urology, APHP, CHU Henri Mondor, Créteil, France.
Urology. 2012 Sep;80(3):576-84. doi: 10.1016/j.urology.2012.04.066.
To evaluate the impact of obesity on the outcomes of laparoscopic radical prostatectomy.
In a prospective urologic cancer database, 765 patients underwent extraperitoneal laparoscopic radical prostatectomy for localized prostate cancer. The patients were categorized into 3 groups of body mass index (kg/m(2)): <25.0 (n = 276, 30%, "normal weight"), 25.0 to 30.0 (n = 365, 48%, "overweight") and >30.0 (n = 124, 16%, "obese"). We assessed the perioperative, oncological, and functional outcomes in this cohort of patients. Preoperative and postoperative evaluation of continence and erectile function were performed using validated questionnaires.
Mean operative time was significantly longer in obese patients (P < .001) and blood loss was also more important (P < .01). The obese patients had the highest likelihood of having aggressive tumors: nonorgan confined prostate cancer (49%, P = .002) and Gleason score ≥ 7 (80%, P = .005). The obese group had the higher positive surgical margins rate (overall: 27%, P = .012; pT2: 20%, P = .02). With a mean follow-up of 38 months, obesity was not an independent predictive factor of biochemical recurrence. At the 12-month follow-up, 85%, 74%, and 72% of normal, overweight, and obese men, respectively, were continent (no pad) (P = .04). At the 12-month follow-up, 57%, 58%, and 40% of normal, overweight, and obese men, respectively, reported an erection sufficient for intercourse (P = .01).
Laparoscopic radical prostatectomy is a safe and effective procedure in obese men with midterm cancer control. However, obese patients are at higher risk of aggressive disease. Recovery of continence and potency in these patients are significantly lower compared to nonobese men.
评估肥胖对腹腔镜根治性前列腺切除术结果的影响。
在一个前瞻性的泌尿科癌症数据库中，765 名患者接受了经腹腹腔镜根治性前列腺切除术治疗局限性前列腺癌。将患者分为 3 组体重指数（kg/m2）：<25.0（n=276，30%，“正常体重”），25.0-30.0（n=365，48%，“超重”）和>30.0（n=124，16%，“肥胖”）。我们评估了这组患者的围手术期、肿瘤学和功能结果。使用经过验证的问卷对术前和术后的控尿和勃起功能进行评估。
肥胖患者的手术时间明显更长（P<.001），出血量也更多（P<.01）。肥胖患者患侵袭性肿瘤的可能性最大：非器官局限性前列腺癌（49%，P=.002）和 Gleason 评分≥7（80%，P=.005）。肥胖组的阳性切缘率较高（总体：27%，P=.012；pT2：20%，P=.02）。平均随访 38 个月后，肥胖不是生化复发的独立预测因素。在 12 个月的随访中，分别有 85%、74%和 72%的正常体重、超重和肥胖男性（无垫）无尿失禁（P=.04）。在 12 个月的随访中，分别有 57%、58%和 40%的正常体重、超重和肥胖男性报告勃起功能足以进行性交（P=.01）。
腹腔镜根治性前列腺切除术在患有中期癌症的肥胖男性中是一种安全有效的方法。然而，肥胖患者患侵袭性疾病的风险更高。与非肥胖男性相比，这些患者的控尿和勃起功能恢复明显较低。
