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Functional and oncological outcomes of robot-assisted radical prostatectomy in obese men: a matched-pair analysis

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Abstract

Robot-assisted radical prostatectomy (RARP) in men with body mass index (BMI) ≥ 35 kg/m2 is considered technically challenging. We conducted a retrospective matched-pair analysis to compare the oncological and functional outcomes of RARP in men with BMI ≥ 35 kg/m2. We interrogated our prospectively maintained RARP database and identified 1273 men who underwent RARP from January 2018 till June 2021. Among them, 43 had BMI ≥ 35 kg/m2, and 1230 had BMI < 35 kg/m2. A 1:1 genetic matching was performed between these two groups for PSA, Gleason grades, clinical stage, D'Amico risk stratification, and nerve-spare extent. Continence rates and biochemical rates on 1-year follow-up were analysed. We performed statistical analysis using SPSS, and Paired tests were done using Wilcoxon sign rank-sum test. p < 0.05 was considered statistically significant. The two groups were comparable in almost all parameters except for age. Console time (p = 0.20) and estimated blood loss (p > 0.90) were not significantly different. There was no blood transfusion, open conversion or (Clavien–Dindo grade ≥ 3) intra/postoperative complication in either of the two groups. The two groups did not have any difference in biochemical recurrence rates (BCR) on 1-year follow-up (p > 0.90). Men with BMI ≥ 35 achieved continence rates equivalent to men with BMI < 35 within 1 year. On logistic regression analysis, age (p < 0.001) and extent of nerve sparing (p = 0.026) emerged as significant factors influencing continence recovery. RARP is safe in men with BMI ≥ 35 kg/m2. The 1-year continence and oncological outcomes are similar to matched men with BMI < 35 kg/m2 undergoing RARP.

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Funding

No funding was received for conducting the study.

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Authors and Affiliations

  1. Department of Urology, Royal Surrey County Hospital, Guildford, UK

    Danny Darlington Carbin Joseph, Sabina Dranova, Holly Harrison, Dimitrios Papanikolou, Santiago Uribe, Mark Broe, Costantinos Adamou, Danielle Whiting, Gerasimos Frajkoulis, Dimitrios Moschonas, Krishna Patil, Venkata Ramana Murthy Kusuma, James Hicks, Wissam Abou Chedid & Matthew James Alexander Perry

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  1. Danny Darlington Carbin Joseph
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  2. Sabina Dranova
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  3. Holly Harrison
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  15. Matthew James Alexander Perry
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DDC. The first draft of the manuscript was written by DDC and all the other authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Danny Darlington Carbin Joseph.

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All the authors declare no conflict of interest.

Ethical clearance

This retrospective study was performed in line with the principles of the Declaration of Helsinki. The study was performed as an audit of obese men who underwent RARP in our unit. Audit number:SU-CA-21-22-104.

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Carbin Joseph, D.D., Dranova, S., Harrison, H. et al. Functional and oncological outcomes of robot-assisted radical prostatectomy in obese men: a matched-pair analysis. J Robotic Surg 17, 2027–2033 (2023). https://doi.org/10.1007/s11701-023-01607-w

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  • DOI: https://doi.org/10.1007/s11701-023-01607-w

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