Perioperative and early oncological outcomes after robot-assisted radical prostatectomy (RARP) in morbidly obese patients: a propensity score-matched study
Menée sur 3 041 patients atteints d'un cancer de la prostate traité entre 2008 et 2012, cette étude évalue, du point de vue de données opératoires et des complications intra- ou post-opératoires, la faisabilité d'une prostatectomie radicale assistée par robot en fonction de catégories d'indice de masse corporelle (44 cas d'obésité morbide)
Objective * To evaluate the perioperative and pathological outcomes associated with robot-assisted radical prostatectomy (RARP) in morbidly obese men. Patients and Methods * Between January 2008 and March 2012, 3041 patients underwent RARP at our institution by a single surgeon (V.P.). * In all, 44 patients were considered morbidly obese with a body mass index (BMI) of ≥40 kg/m2. * A propensity score-matched analysis was conducted using multivariable analysis to identify comparable groups of patients with a BMI of ≥40 and <40 kg/m2. * Perioperative, pathological outcomes and complications were compared between the two matched groups. Results * There was no significant difference in operative time. However, the mean estimated blood loss was higher in morbidly obese patients, at a mean (sd) of 113 (41) vs 130 (27) mL (P = 0.049). * Anastomosis was more difficult in morbidly obese patients (P = 0.001). * There were no significant differences in laterality, ease of nerve sparing, or transfusion rate between the groups. * There were no intraoperative complications in either group. Postoperative pathological outcomes were similar between the groups. * Differences in positive surgical margins and ease of nerve sparing approached statistical significance (P = 0.097, P = 0.075 respectively). Postoperative complication rates, pain scores, length of stay and indwelling catheter duration were similar in the groups. Conclusions * RARP in morbidly obese patients is technically demanding. However, it can be accomplished with acceptable morbidity and resource use. * In the hands of an experienced surgeon, it is a safe procedure and offers beneficial clinical outcomes.