title: Radical prostatectomy in obese patients: Improved surgical outcomes in recent years.
abstract: OBJECTIVE
  Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP.
  
  
  METHODS
  Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were divided into three groups based on their body mass index (BMI): <25, 25-30 (overweight) and >30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores.
  
  
  RESULTS
  Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18-1.09), were not shown.
  
  
  CONCLUSIONS
  As surgical experience with high BMI patients has developed, RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar.
authors.affiliation: Division of Urology, Department of Surgical Oncology Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Uri
authors.initials: U
authors.lastname: Lindner
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner
authors.forename: John
authors.initials: J
authors.lastname: Trachtenberg
mesh_terms: D000368:Aged; D015992:Body Mass Index; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects* / Q000639:trends; D011471:Prostatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome