title: Laparoscopic and robotic radical prostatectomy outcomes in obese and extremely obese men.
abstract: OBJECTIVE
  To evaluate the operative and pathologic outcomes of laparoscopic radical prostatectomy and robot-assisted radical prostatectomy in men with progressive changes in body mass index (BMI) category.
  
  
  METHODS
  A single-surgeon series of 1023 laparoscopic radical prostatectomy and robot-assisted radical prostatectomy (mostly extraperitoneal) patients was considered. Of these patients, 987 were evaluable. Results were stratified by the World Health Organization BMI category. Multivariate linear and logistic regression analysis was used to model the operating time, length of stay, positive surgical margins, and noncurable cancer.
  
  
  RESULTS
  Of the 987 patients, 563 (57%) were overweight and 193 (19.6%) were obese. Of the 193 obese patients, 152 (15.4%) had a BMI of 30 to <35 kg/m(2) (class I obesity), 28 (2.8%) a BMI of 35 to <40 kg/m(2) (class II), and 13 (1.3%) a BMI of ≥40 kg/m(2) (class III). No differences were found in the estimated blood loss, complications, PSM, pathologic stage, or biochemical recurrence across the BMI categories (6-month median follow-up). However, pelvic lymph node dissection was more commonly omitted and the nerve-sparing score was inferior in the obese men. On multivariate analysis, a higher BMI was a significant predictor of a longer operating time.
  
  
  CONCLUSIONS
  Obese men can safely undergo laparoscopic radical prostatectomy or robot-assisted radical prostatectomy, although the ability to perform excellent nerve sparing appears to decrease with increasing obesity. Nevertheless, obese men can expect perioperative and early oncologic outcomes comparable to those of normal weight men without an increased risk of perioperative complications.
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA. dsundi1@jhmi.edu
authors.forename: Debasish
authors.initials: D
authors.lastname: Sundi
authors.forename: Adam C
authors.initials: AC
authors.lastname: Reese
authors.forename: Lynda Z
authors.initials: LZ
authors.lastname: Mettee
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: Christian P
authors.initials: CP
authors.lastname: Pavlovich
mesh_terms: D016063:Blood Loss, Surgical; D015992:Body Mass Index; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009765:Obesity / Q000150:complications*; D009767:Obesity, Morbid / Q000150:complications; D061646:Operative Time; D059351:Organ Sparing Treatments; D010388:Pelvis; D059348:Peripheral Nerve Injuries / Q000517:prevention & control; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen