Open Versus Robotic Radical Prostatectomy in Obese Men.

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robotic-assisted radical prostatectomy (RARP) offers potential benefits over open radical prostatectomy (ORP), including reduced blood loss and shorter hospital stays.
• The efficacy and safety of RARP in obese patients, a population with unique surgical considerations, require specific investigation.

Purpose of the Study:

• To evaluate whether the established advantages of RARP over ORP extend to obese patients undergoing radical prostatectomy.
• To compare peri-operative outcomes, including complications, blood transfusions, and length of stay, between RARP and ORP in obese men with prostate cancer.

Main Methods:

• A retrospective analysis of the 2009-2010 Nationwide Inpatient Sample database was conducted.
• Obese men diagnosed with prostate cancer who underwent either ORP or RARP were identified.
• Multivariable logistic regression models were used to assess the association between surgical approach (RARP vs. ORP) and peri-operative adverse events.

Main Results:

• The study identified 9,108 obese patients who underwent radical prostatectomy.
• RARP was not independently associated with a reduced risk of peri-operative complications compared to ORP (OR = 0.81, p = 0.209).
• However, RARP was significantly associated with decreased odds of requiring blood transfusion (OR = 0.17, p < 0.001) and experiencing a prolonged length of stay (OR = 0.28, p < 0.001).

Conclusions:

• In obese patients, RARP demonstrates significant benefits in reducing the likelihood of blood transfusions and shortening hospital stays when compared to ORP.
• Despite these advantages, the risk of peri-operative complications was comparable between RARP and ORP in this obese cohort.
• These findings suggest that RARP is a viable and potentially advantageous option for obese patients undergoing radical prostatectomy, particularly concerning transfusion and length of stay outcomes.