1 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York.
2 Robotic Urologic Surgery, Ohio Health Dublin Methodist Hospital, Columbus, Ohio.
J Endourol. 2019 Jun;33(6):431-437. doi: 10.1089/end.2019.0018.
As the prevalence of obesity increases worldwide, an increasing proportion of surgical candidates have an elevated body mass index (BMI), with associated metabolic syndrome. Yet there exists limited evidence regarding the effect of elevated BMI on surgical outcomes in robotic surgeries. We examined whether obese patients had worse perioperative outcomes and postoperative renal function after robotic partial nephrectomies (RPNs). We performed a multi-institutional analysis of 1770 patients who underwent RPNs between 2008 and 2015, allowing time for the data set to mature. Associations between BMI, as a continuous and categorical variable, and perioperative outcomes, acute kidney injury (AKI, >25% reduction in estimated glomerular filtration rate [eGFR]) at discharge, and change in eGFR per month were analyzed. AKI and eGFR were evaluated using multivariable logistic and linear regression models adjusted for confounders, including age, Charlson comorbidity index, tumor size, and the identity of the surgeon. In total 45.2% ( = 529) of patients were found to be obese, with a greater prevalence of hypertension and diabetes in overweight and obese patients. Obese patients were more likely to have malignant tumors (>77% 68%, < 0.001) and trended toward having larger tumors (3.0 cm 2.8 cm; = 0.061). Heavier patients required longer operative times (166-196 minutes 155 minutes; < 0.001), although equivalent warm ischemia times ( = 0.873). Obesity did not correlate with an increased complication rate ( > 0.05). On multivariable analysis, obesity (odds ratio [OR] = 1.81; = 0.031), male sex (OR = 1.54; = 0.028), and larger tumor size (OR = 1.23; < 0.001) were associated with a significant increase in the likelihood of AKI at discharge. BMI above normal weight was not associated with greater eGFR decline per month post-RPN. Obesity was associated with equivalent perioperative outcomes and long-term renal function. Further research is warranted into how obesity and metabolic syndrome may foster a more aggressive tumor environment. RPN appears to be an equally safe operative option for patients regardless of obesity status.
随着全球肥胖症患病率的增加，越来越多的手术候选人的体重指数（BMI）升高，伴有代谢综合征。然而，关于肥胖症对机器人手术中手术结果的影响，证据有限。我们研究了肥胖患者在机器人部分肾切除术（RPN）后的围手术期结局和术后肾功能是否较差。我们对 2008 年至 2015 年间接受 RPN 的 1770 名患者进行了多机构分析，为数据集的成熟留出了时间。分析了 BMI 与围手术期结局、出院时急性肾损伤（AKI，估计肾小球滤过率[eGFR]下降>25%）以及每月 eGFR 变化之间的关联，BMI 作为连续和分类变量。使用多变量逻辑和线性回归模型调整混杂因素（包括年龄、Charlson 合并症指数、肿瘤大小和外科医生身份）后，评估了 AKI 和 eGFR。共有 45.2%（529/1170）的患者被发现肥胖，超重和肥胖患者高血压和糖尿病的患病率更高。肥胖患者更有可能患有恶性肿瘤（>77%比 68%，<0.001），且肿瘤较大的趋势（3.0cm 比 2.8cm；=0.061）。较重的患者需要更长的手术时间（166-196 分钟比 155 分钟；<0.001），但等效的热缺血时间（=0.873）。肥胖与并发症发生率增加无关（>0.05）。多变量分析显示，肥胖（优势比[OR] 1.81；=0.031）、男性（OR 1.54；=0.028）和较大的肿瘤大小（OR 1.23；<0.001）与出院时 AKI 发生的可能性显著增加相关。BMI 高于正常体重与 RPN 后每月 eGFR 下降无关。肥胖与等效的围手术期结局和长期肾功能相关。需要进一步研究肥胖症和代谢综合征如何促进更具侵袭性的肿瘤环境。RPN 似乎是肥胖患者安全的手术选择。
