title: A single-institution comparison between radical perineal and radical retropubic prostatectomy on perioperative and pathological outcomes for obese men: an analysis of the Duke Prostate Center database.
abstract: OBJECTIVE
  To examine the association between body mass index (BMI) and operative time, estimated blood loss (EBL), and adverse pathologic features in patients undergoing either radical perineal prostatectomy (RPP) or radical retropubic prostatectomy (RRP).
  
  
  METHODS
  We performed a retrospective analysis of 1006 patients treated with RPP or RRP at our institution from 1988 to 2005. Operative times and EBL were compared among BMI groups for both RPP and RRP. The odds ratio of positive surgical margins was estimated for the BMI categories using logistic regression after adjusting for preoperative and pathologic characteristics.
  
  
  RESULTS
  Increased BMI was significantly associated with increased operative time and EBL for men treated with either RPP or RRP (all P < or = 0.03), though the associations were weak (all Spearman r < or = 0.19). After adjusting for multiple clinical preoperative characteristics, higher BMI was associated with positive surgical margins among all patients (P trend <0.001). The association between obesity and surgical margins remained after adjusting for pathologic characteristics (P trend = 0.001) with similar patterns among RRP (P trend = 0.03) and RPP (P trend = 0.01) patients.
  
  
  CONCLUSIONS
  For mildly obese men, both RPP and RRP are associated with a similarly increased risk of higher EBL, longer operative time, and positive surgical margins. These data do not provide evidence to suggest that RPP should be preferred over RRP for mildly obese men. Further study is needed among men with a very high BMI.
authors.affiliation: Division of Urologic Surgery, Duke University School of Medicine, Durham, North Carolina 27710, USA. nicholas.fitzsimons@duke.edu
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Fitzsimons
authors.forename: Leon L
authors.initials: LL
authors.lastname: Sun
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: John
authors.initials: J
authors.lastname: Madden
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D016063:Blood Loss, Surgical; D015992:Body Mass Index; D006801:Humans; D008297:Male; D008787:Metoclopramide; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery
chemical_list: D008787:Metoclopramide