Gözen Ali Serdar, Akin Yigit, Özden Ender, Ates Mutlu, Hruza Marcel, Rassweiler Jens
Department of Urology, SLK Kliniken, University of Heidelberg , Heilbronn , Germany.
Scand J Urol. 2015 Feb;49(1):70-6. doi: 10.3109/21681805.2014.920416. Epub 2014 Aug 18.
The aim of this study was to investigate the impact of body mass index (BMI) on the functional and oncological results of patients who had undergone laparoscopic radical prostatectomy (LRP).
In total, 1224 patients with follow-up data (>24 months) were enrolled. Patients were divided into three groups according to BMI (kg/m(2)) as: group 1 (normal, BMI <25, n = 425), group 2 (overweight, 25 ≤ BMI <30, n = 594) and group 3 (obese, BMI ≥ 30, n = 205). Demographic, intraoperative and postoperative data with oncological outcomes were recorded. The impact of obesity on those parameters was evaluated and statistical analyses were performed.
Mean age was 63.8 ± 6.1 years and mean follow-up was 43.1 ± 25.1 months (mean ± SD). There were 425 (34.7%) patients in group 1, 594 (48.5%) in group 2 and 205 (16.8%) in group 3. Operation time, clinical stage and estimated blood loss were significantly higher in group 3 than in the other groups (p < 0.001, p = 0.001 and p = 0.001, respectively). Bilateral nerve-sparing rate and bladder neck-sparing rate were significantly decreased in group 3 compared with the other groups (p = 0.001 and p < 0.038, respectively). Statistically significantly higher pathological stage, tumour volume, positive surgical margin and Gleason scores were determined in group 3 compared with the other groups (p = 0.023, p = 0.018, p = 0.009 and p = 0.028, respectively). There were similar urinary continence rates among the groups. The rate of penetration with or without medication was significantly lower in group 3 than in the other groups (p = 0.593 and p = 0.007, respectively).
LRP seemed safe and effective in obese patients, with similar mean overall survival, cancer-specific survival, complication rates and continence rates to normal weight patients in the long term.
本研究旨在调查体重指数（BMI）对接受腹腔镜根治性前列腺切除术（LRP）患者的功能和肿瘤学结果的影响。
总共纳入了1224例有随访数据（>24个月）的患者。根据BMI（kg/m²）将患者分为三组：第1组（正常，BMI<25，n = 425），第2组（超重，25≤BMI<30，n = 594）和第3组（肥胖，BMI≥30，n = 205）。记录人口统计学、术中及术后数据以及肿瘤学结果。评估肥胖对这些参数的影响并进行统计分析。
平均年龄为63.8±6.1岁，平均随访时间为43.1±25.1个月（平均值±标准差）。第1组有425例（34.7%）患者，第2组有594例（48.5%）患者，第3组有205例（16.8%）患者。第3组的手术时间、临床分期和估计失血量显著高于其他组（分别为p<0.001、p = 0.001和p = 0.001）。与其他组相比，第3组的双侧神经保留率和膀胱颈保留率显著降低（分别为p = 0.001和p<0.038）。与其他组相比，第3组的病理分期、肿瘤体积、手术切缘阳性率和Gleason评分在统计学上显著更高（分别为p = 0.023、p = 0.018、p = 0.009和p = 0.028）。各组间尿失禁率相似。第3组无论有无药物辅助的阴茎勃起功能障碍发生率均显著低于其他组（分别为p = 0.593和p = 0.007）。
LRP对肥胖患者似乎是安全有效的，从长期来看，其平均总生存率、癌症特异性生存率、并发症发生率和尿失禁率与正常体重患者相似。
