title: The impact of prostate size on perioperative outcomes in a large laparoscopic radical prostatectomy series.
abstract: OBJECTIVE
  To clarify the effects of pathologic prostate specimen weight on perioperative outcomes in laparoscopic radical prostatectomy (LRP), a subject that has recently been analyzed in numerous smaller series.
  
  
  METHODS
  Data from our Institution Review Board-approved database was queried with attention to operative, perioperative, and pathologic outcomes. For analysis, LRP patients were divided into three groups by pathologic specimen weight: <35 g, 35 to 70 g, and >70 g, and outcomes assessed. Outcomes were also analyzed using prostate weight as a continuous variable by multivariate regression.
  
  
  RESULTS
  Between April 2001 and April 2007, 802 consecutive patients underwent LRP for localized prostate cancer, and complete perioperative data were available for 720 (90%) of these men. Mean age, body mass index (BMI), preoperative prostate-specific antigen (PSA) and postoperative Gleason score were 57.6 years, 26.7 kg/m(2), 5.9 ng/mL, and 6.3, respectively. Mean specimen weight was 51.3 g. When compared with lighter counterparts, patients with the heaviest glands were older (P < 0.01), had a higher PSA level (P < 0.01), and had a higher percentage of pathologically organ-confined disease (P < 0.01). By multivariate regression analysis, increasing prostate weight was associated with longer operative times, more blood loss, longer lengths of stay, and more perioperative complications (all P < 0.05). Of note, smaller glands trended toward a higher rate of positive surgical margins overall (P = 0.07) and in pT(2) disease (P = 0.05), but there was no association between surgical margins and gland size in pT(3) disease (P = 0.27). Increasing BMI was also independently predictive of positive margins regardless of prostate size (P < 0.01).
  
  
  CONCLUSIONS
  Although perioperative outcomes are generally excellent after LRP irrespective of gland size, a larger prostate size is associated with longer operative time, more blood loss, longer length of stay, and increased complications. Patients with smaller glands and organ-confined disease appear to have a higher rate of positive surgical margins.
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. doctorlevinson@gmail.com
authors.forename: Adam W
authors.initials: AW
authors.lastname: Levinson
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Ward
authors.forename: Aaron
authors.initials: A
authors.lastname: Sulman
authors.forename: Lynda Z
authors.initials: LZ
authors.lastname: Mettee
authors.forename: Richard E
authors.initials: RE
authors.lastname: Link
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Su
authors.forename: Christian P
authors.initials: CP
authors.lastname: Pavlovich
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D019990:Perioperative Care; D011467:Prostate / Q000473:pathology* / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D016896:Treatment Outcome