Laparoscopic radical prostatectomy and body mass index: an assessment of 151 sequential cases

Little objective data are available regarding obesity and the performance of laparoscopic radical prostatectomy (LRP). We reviewed our LRP series to determine the effect of body mass index (BMI) on operative time, blood loss, anastomotic leakage, positive margins, length of stay, complications, urinary continence and erectile function.

A single institution retrospective review was performed of 151 sequential LRPs performed by a single surgeon. Patients were separated into those who were nonobese (BMI less than 30), and those with classes I (BMI 30 to 34.9), II (BMI 35 to 39.9) and III (BMI 40 or greater) obesity according to WHO criteria.

There were 97 patients in the nonobese and 54 in the obese cohort, including 35, 14 and 5 with classes I to III obesity, respectively. A trend toward greater preoperative prostate specific antigen (p = 0.14), Gleason score (p = 0.06) and American Society of Anesthesiologists classification (p = 0.07) was noted in the obese (BMI 30 or greater) group. The cohorts had similar prostate size (p = 0.11), pathological grade (p = 0.57), pathological stage (p = 0.50), postoperative hemoglobin decrease (p = 0.77) and hospital stay (p = 0.90). The rates of positive margins (p = 1.0), anastomotic leakage (p = 0.49), prostate specific antigen recurrence (p = 1.0) and complication (p = 0.14) were also similar. Early postoperative urinary continence (p = 1.0) and erectile function (p = 0.19) appeared equivalent. Mean operative time +/- SD was greater in obese than in nonobese patients (208 +/- 43 vs 192 +/- 34 minutes, p = 0.02). Mean operative time was longer in patients with classes II and III obesity (220 +/- 47 minutes, p <0.05 and 249 +/- 32, p <0.01, respectively). The class III group had a longer mean operative time than the class I obesity group (198 +/- 34 minutes, p <0.05). Obese patients underwent a greater number of additional procedures at the time of LRP (p = 0.01).

While obesity significantly increased LRP operative time, it did not significantly impact other intraoperative and postoperative surgical parameters. LRP should be offered to obese patients as a feasible and effective treatment option for prostate cancer.