title: Obesity and positive surgical margins by anatomic location after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database.
abstract: OBJECTIVE
  To determine if there is predilection for any specific anatomical location of positive surgical margins (PSMs) after radical prostatectomy (RP) for prostate cancer in obese men, as previous studies found that obesity was associated with an increased risk of PSMs.
  
  
  METHODS
  We analysed retrospectively 1434 men treated with RP between 1989 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The association between increased body mass index (BMI) and overall and site-specific PSMs was assessed using multivariate logistic regression.
  
  
  RESULTS
  After adjusting for several preoperative clinical and pathological characteristics, a higher BMI was associated with an increased risk of PSMs both overall and at all specific anatomical locations (all P <or= 0.007). For mildly obese men, this risk was very similar across all anatomical sites (44-78% increased risk relative to men of normal weight). When BMI was coded as a continuous variable, the odds ratio for the risk of overall PSMs or at any specific locations was nearly identical at 1.05-1.06. Among men with a BMI of >or=35 kg/m2, there was more variation, with the highest excess risk of PSMs at the bladder neck and apex.
  
  
  CONCLUSIONS
  Obesity was associated with an increased risk of overall PSMs and at all anatomical locations. Although the excess risk of PSMs was similar across all anatomical locations, there was a suggestion of a higher risk of apical margins among the most obese men, which if validated, further supports the importance of the apical dissection in all men and suggests added difficulty in obese patients.
authors.affiliation: Urology Section, Veterans Affairs Medical Center, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Jayakrishnan
authors.initials: J
authors.lastname: Jayachandran
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Presti
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D015992:Body Mass Index; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome