Farzat Mahmoud, Sharabaty Ismail, Tanislav Christian, Alsaid Yaman, Wagenlehner Florian M
Department of Robotic Urology, Diakonie Klinikum Siegen, Academic Teaching Hospital, University of Bonn, 53127 Bonn, Germany.
Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35390 Giessen, Germany.
J Clin Med. 2023 Jun 7;12(12):3908. doi: 10.3390/jcm12123908.
Due to more difficult intraoperative courses, elevated rates of case abortion and unfavored postoperative outcomes in obese patients, urologists tend to consider other therapeutic modalities than prostate removal in very obese patients. With the surge in robotic surgery in the last two decades, more obese patients have undergone robot-assisted radical prostatectomy (RARP).
This current, monocentric, retrospective serial study investigates primarily the impact of obesity on readmissions and secondarily the major complications of RARP.
Five hundred patients from one referral center who underwent RARP between April 2019 and August 2022 were included in this retrospective study. To investigate the impact of patient BMI on postoperative outcomes, we divided our cohort into two groups with a cut-off of 30 kg/m (according to the WHO definition). Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard, normal patients (NOBMI-BMI under 30; n = 336, 67.2%) and overweight patients (OBMI-BMI equal to/more than 30; n = 164, 32.8%).
OBMI patients had bigger prostates on TRUS, more comorbidities and worse baseline erectile function scores. They also received fewer nerve-sparing procedures than their counterparts ( = 0.005). Analysis showed no statistically significant differences in readmission rates or in minor or major complications ( = 0.336, 0.464 and 0.316, respectively). In a univariate analysis, BMI could predict positive surgical margins ( = 0.021).
Performing RARP in obese patients seems to be safe and feasible, without major adverse events or elevated readmission rates. Obese patients should be informed preoperatively about the elevated risk of higher PSMs and technically more difficult nerve-sparing procedures.
由于肥胖患者术中过程更困难、病例流产率升高以及术后不良结局，泌尿外科医生倾向于在极度肥胖患者中考虑除前列腺切除之外的其他治疗方式。在过去二十年中，随着机器人手术的激增，越来越多的肥胖患者接受了机器人辅助根治性前列腺切除术（RARP）。
这项当前的单中心回顾性系列研究主要调查肥胖对再入院的影响，其次调查RARP的主要并发症。
本回顾性研究纳入了2019年4月至2022年8月期间在一个转诊中心接受RARP的500例患者。为了研究患者BMI对术后结局的影响，我们将队列分为两组，以30kg/m为临界值（根据世界卫生组织的定义）。分析了人口统计学和围手术期数据。比较了标准的正常患者（非肥胖组——BMI低于30；n = 336，67.2%）和超重患者（肥胖组——BMI等于/大于30；n = 164，32.8%）的术后并发症和再入院率。
肥胖组患者经直肠超声检查显示前列腺更大，合并症更多，基线勃起功能评分更差。他们接受保留神经手术的次数也比非肥胖组患者少（P = 0.005）。分析显示，再入院率、轻微或严重并发症方面无统计学显著差异（分别为P = 0.336、0.464和0.316）。在单因素分析中，BMI可预测手术切缘阳性（P = 0.021）。
在肥胖患者中进行RARP似乎是安全可行的，没有重大不良事件或再入院率升高。应在术前告知肥胖患者手术切缘阳性风险较高以及保留神经手术在技术上更困难的风险。
