title: [DaVinci robot-assisted laparoscopic prostatectomy: benefit for obese men? - A matched-pair analysis].
abstract: BACKGROUND
  Open radical retropubic prostatectomy (RRP) in obese patients (BMI ≥30) is associated with increased perioperative morbidity. The aim of the study was to evaluate the possible benefit of DaVinci robotic-assisted laparoscopic prostatectomy (RARP) compared to RRP in obese patients.
  
  
  METHODS
  We identified 255 patients with a localized prostate cancer (PCa) and BMI ≥30 treated with radical prostatectomy from January 2009 to December 2011. To adjust for risk factors of increased perioperative morbidity (nerve-sparing, pelvic lymph node dissection, prostate volume), a propensity score-based matching was performed between RRP and RARP (n=115 each group). Both groups were compared by taking into consideration histopathological outcomes as well as peri- and postoperative (30 days) morbidity.
  
  
  RESULTS
  There were no differences in histopathological characteristics (pT/pN-stage, Gleason score, R-stage; all p>0.05) in both groups. Mean blood loss (276 ml vs. 937 ml), transfusion rate (0.9% vs. 8.7%) and 30-day complications according to the Clavien classification system (Clavien ≥ 2; 9.5% vs. 22.6%) were decreased in RARP (all p<0.05). In a multivariate logistic regression model, RARP vs. RRP was associated with a significantly reduced risk of a Clavien ≥ 2 complication during follow-up (OR 0.3; p= 0.0047). Recovery of continence was significantly better for RARP patients after 3 months (p= 0.02). There was no difference in erectile function 12 months postoperatively.
  
  
  CONCLUSIONS
  Our findings of decreased transfusion and complication rates and a trend of better early recovery of continence in RARP should be considered in obese patients (BMI >30) scheduled for radical prostatectomy.
authors.affiliation: Martini-Klinik Hamburg, Martinistraße 52, 20246, Hamburg, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Beyer
authors.forename: K
authors.initials: K
authors.lastname: Kühne
authors.forename: K
authors.initials: K
authors.lastname: Böhm
authors.forename: J
authors.initials: J
authors.lastname: Schiffmann
authors.forename: H
authors.initials: H
authors.lastname: Heinzer
authors.forename: U
authors.initials: U
authors.lastname: Michl
authors.forename: H
authors.initials: H
authors.lastname: Huland
authors.forename: M
authors.initials: M
authors.lastname: Graefen
authors.forename: A
authors.initials: A
authors.lastname: Haese
authors.forename: T
authors.initials: T
authors.lastname: Steuber
mesh_terms: D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D020127:Recovery of Function; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome