Obesity May Not Impact Outcomes From Robotic Prostate Surgery
At the recent 25th Annual European Association of Urology Congress, Dr. David Samadi, Chief of the Division of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York City, presented findings that showed that obesity does not adversely impact the outcomes of robotic-assisted laparoscopic prostatectomies (RALP) for prostate cancer treatment. These findings contradict the popular opinion that non-obese patients fare better than their obese counterparts after having robotic surgery for prostate cancer.
Dr. Samadi presented findings from a study that followed 1,112 men who underwent RALP for prostate cancer treatment. The results were that the perioperative, pathologic, and functional outcomes were the same regardless if the patients were obese or not. "Previously it had been thought that obese patients do not do well after RALP because of the way their high BMI affects their outcomes, but there wasn't enough data to support that notion," said Dr. Samadi. Ironically, previous data has shown that obese patients have worse outcomes with traditional open prostatectomy versus a robotic prostatectomy.
In fact, the new study showed that both obese and non-obese subjects had similar Gleason scores (a grading system used to predict the behavior of prostate cancer), positive margins, biochemical recurrence, and surgical complications. They had comparable operating times and approximate blood loss. Their post-operative continence rates were similar at three, six, and 12 months. Their post-operative sexual function rates were also very similar at the same stages. "While there is an increased incidence of prostate cancer in men with high BMI, the bottom line is that RALP is effective and safe for these types of patients," Dr. Samadi said.
"The only barrier to operating on an obese patient would be the surgical challenges that arise as a result of their body mass," explained Dr. Samadi. A typical RALP takes Dr. Samadi about 90 minutes to perform. With obese patients, surgeries can often go beyond three hours, and if the surgeon does not have the required experience with these kinds of cases, many complications such as DVT, blood clots in lower extremities or overall edema can arise. "I always recommend that a very experienced, high-volume surgeon perform the procedure," advised Samadi.