Periprostatic fat area is an independent factor that prolonged operative time in laparoscopic radical prostatectomy.
OBJECTIVE
To evaluate the effect of visceral obesity on surgical outcomes in laparoscopic radical prostatectomy (LRP).


METHODS
Visceral fat area (VFA) and periprostatic fat area (PPFA) were used as index of visceral obesity. In addition to VFA and PPFA, age, body mass index (BMI), prostate weight, cross-section area of Retzius space, history of previous abdominal surgery, repeated transrectal needle biopsy, and neoadjuvant hormone therapy were recorded. LRP was separated into 7 steps (1: port insertion and lymph node dissection, 2: endopelvic fascia incision, 3: dorsal vein complex ligation, 4: prostate dissection from bladder neck, 5: dissection of seminal vesicle and vas deferens, 6: prostate dissection from rectum, and 7: vesicourethral anastomosis). Potential factors that prolonged total operative time (OT), pneumoperitoneum time, and duration of each step were assessed by multivariate logistic regression analysis. The association between visceral obesity and other surgical outcomes was also evaluated.


RESULTS
One hundred sixteen LRPs were performed by a single experienced surgeon. High PPFA and prostate weight were independent factors that prolonged total OT and pneumoperitoneum time. High BMI was not a factor. PPFA affected steps 1, 4, 5, and 6, and prostate weight affected prolonged steps 5 and 6. Estimated blood loss, duration of urethral catheterization, postoperative hospital stay, perioperative complications, and margin status were not affected by visceral obesity.


CONCLUSIONS
PPFA was more useful to accurately predict prolonged OT than VFA or BMI. Safety and margin status were not compromised even in high PPFA group when operations were performed by an experienced surgeon.
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Gou
G
Kaneko
Akira
A
Miyajima
Kazuyuki
K
Yuge
Masanori
M
Hasegawa
Toshikazu
T
Takeda
Masahiro
M
Jinzaki
Eiji
E
Kikuchi
Ken
K
Nakagawa
Mototsugu
M
Oya
D000368:Aged; D015992:Body Mass Index; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology*; D061646:Operative Time; D009929:Organ Size; D011028:Pneumoperitoneum, Artificial; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*