title: Impact of body mass index on perioperative morbidity, oncological, and functional outcomes after extraperitoneal laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To evaluate the impact of obesity on the outcomes of laparoscopic radical prostatectomy.
  
  
  METHODS
  In a prospective urologic cancer database, 765 patients underwent extraperitoneal laparoscopic radical prostatectomy for localized prostate cancer. The patients were categorized into 3 groups of body mass index (kg/m(2)): <25.0 (n = 276, 30%, "normal weight"), 25.0 to 30.0 (n = 365, 48%, "overweight") and >30.0 (n = 124, 16%, "obese"). We assessed the perioperative, oncological, and functional outcomes in this cohort of patients. Preoperative and postoperative evaluation of continence and erectile function were performed using validated questionnaires.
  
  
  RESULTS
  Mean operative time was significantly longer in obese patients (P < .001) and blood loss was also more important (P < .01). The obese patients had the highest likelihood of having aggressive tumors: nonorgan confined prostate cancer (49%, P = .002) and Gleason score ≥ 7 (80%, P = .005). The obese group had the higher positive surgical margins rate (overall: 27%, P = .012; pT2: 20%, P = .02). With a mean follow-up of 38 months, obesity was not an independent predictive factor of biochemical recurrence. At the 12-month follow-up, 85%, 74%, and 72% of normal, overweight, and obese men, respectively, were continent (no pad) (P = .04). At the 12-month follow-up, 57%, 58%, and 40% of normal, overweight, and obese men, respectively, reported an erection sufficient for intercourse (P = .01).
  
  
  CONCLUSIONS
  Laparoscopic radical prostatectomy is a safe and effective procedure in obese men with midterm cancer control. However, obese patients are at higher risk of aggressive disease. Recovery of continence and potency in these patients are significantly lower compared to nonobese men.
authors.affiliation: Institut National de la Sante et de la Recherche Medicale Unit 955 EQ7, Department of Urology, APHP, CHU Henri Mondor, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Campeggi
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Idir
authors.initials: I
authors.lastname: Ouzaid
authors.forename: Alban
authors.initials: A
authors.lastname: Fabre
authors.forename: Yves
authors.initials: Y
authors.lastname: Allory
authors.forename: Dimitri
authors.initials: D
authors.lastname: Vordos
authors.forename: Claude C
authors.initials: CC
authors.lastname: Abbou
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
mesh_terms: D000368:Aged; D015992:Body Mass Index; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010410:Penile Erection; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome; D014554:Urination