[DaVinci robot-assisted laparoscopic prostatectomy: benefit for obese men? - A matched-pair analysis]

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Obesity (BMI ≥30) increases perioperative risks associated with open radical retropubic prostatectomy (RRP).
• Evaluating alternative surgical approaches is crucial for improving outcomes in obese patients with prostate cancer.

Purpose of the Study:

• To compare the safety and efficacy of DaVinci robotic-assisted laparoscopic prostatectomy (RARP) versus RRP in obese patients (BMI ≥30).

Main Methods:

• A propensity score-matched analysis of 115 obese patients undergoing RARP and 115 undergoing RRP for localized prostate cancer.
• Comparison of histopathological outcomes, perioperative, and 30-day postoperative morbidity between the two groups.

Main Results:

• RARP demonstrated significantly lower mean blood loss (276 ml vs. 937 ml) and transfusion rates (0.9% vs. 8.7%).
• The RARP group experienced fewer 30-day complications (Clavien ≥ 2: 9.5% vs. 22.6%) and a significantly reduced risk of complications (OR 0.3).
• Continence recovery was significantly better at 3 months post-RARP, with no difference in erectile function at 12 months.

Conclusions:

• RARP is associated with decreased transfusion rates and complications in obese patients undergoing radical prostatectomy.
• Robotic-assisted surgery shows a trend towards better early recovery of continence, making it a considerable option for obese patients.