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Matched comparison of robot‐assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients

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Abstract

Objectives

To investigate pathological and oncological outcomes of obese patients who underwent robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (RRP) since limited comparative data exist with regard to oncological and survival outcomes.

Methods

A total of 869 patients with body mass index ≥30 from two academic centers were identified. A total of 194 patients who underwent RARP were propensity score (PS) matched 1:1 to LRP or RRP cases. PS-matching variables included prostate-specific antigen (PSA), biopsy Gleason score, clinical stage, surgeon experience, and nerve-sparing technique. Predictors of positive surgical margins (PSMs) were analyzed using logistic regression. Predictors of recurrence-free survival (RFS) were analyzed within Cox regression models. Overall survival was compared with RFS using the log-rank test.

Results

Pathologic Gleason scores <7, =7, and >7 were found in 24.2, 63.6, and 11.7 % of patients, respectively. There were no statistically significant differences related to pathologic stage or lymph node metastases between surgical techniques. PSM for pT2 disease were observed in 22.9, 17.4, and 19.3 % of patients undergoing RARP, LRP, and RRP, respectively (not significantly different). Preoperative PSA and clinical stage cT2 disease were independently associated with PSM. There were no significant differences in mean 3-year RFS for RARP, LRP, and RRP (87.4, 91.0, and 85.7 %). Biopsy Gleason score >7, PSM, and clinical stage two were independent predictors of decreased RFS.

Conclusions

RARP demonstrates similar pathological and oncological results compared with LRP or RRP for obese patients.

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Abbreviations

BMI:

Body mass index

RP:

Radical prostatectomy

RRP:

Retropubic RP

LRP:

Laparoscopic RP

RARP:

Robot-assisted RP

PSA:

Prostate-specific antigen

PSM:

Positive surgical margin

PS:

Propensity score

BCR:

Biochemical recurrence

RFS:

Recurrence-free survival

OS:

Overall survival

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Acknowledgments

We acknowledge the excellent work of Markus Loos on the Charité prostate cancer database. This study was funded by a Charles Huggins-Grant of the German Society of Urology. Dr. Gonzalgo has served as a consultant to Intuitive Surgical.

Ethical standard

This study was approved by the review boards of both institutions (Stanford, Charité).

Author information

Authors and Affiliations

  1. Department of Urology, Charité University Medicine Berlin, Berlin, Germany

    Jonas Busch, Hannes Cash, Carsten Kempkensteffen, Stefan Hinz, Kurt Miller & Ahmed Magheli

  2. Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, M-814, Miami, FL, 33136, USA

    Mark L. Gonzalgo

  3. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA

    Natalia Leva & Michelle Ferrari

Authors
  1. Jonas Busch
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  2. Mark L. Gonzalgo
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  3. Natalia Leva
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  4. Michelle Ferrari
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  5. Hannes Cash
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  6. Carsten Kempkensteffen
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  7. Stefan Hinz
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  8. Kurt Miller
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  9. Ahmed Magheli
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Corresponding author

Correspondence to Mark L. Gonzalgo.

Additional information

Jonas Busch, Mark L. Gonzalgo and Ahmed Magheli have contributed equally to this work.

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Busch, J., Gonzalgo, M.L., Leva, N. et al. Matched comparison of robot‐assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients. World J Urol 33, 397–402 (2015). https://doi.org/10.1007/s00345-014-1326-1

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  • DOI: https://doi.org/10.1007/s00345-014-1326-1

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