Obesity Does Not Alter RALP Outcomes

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BARCELONA—Contrary to popular opinion, obese prostate cancer patients fare just as well following a robotic-assisted laparoscopic prostatectomy (RALP) as non-obese patients, according to results announced here at the 25th Anniversary European Association of Urology Congress.

David Samadi, MD, Chief of the Division of Robotics and Minimally Invasive Surgery at Mount Sinai Medical Center in New York City, presented findings from 1,112 men who underwent RALP. In all cases, the procedure was performed by Dr. Samadi and the same team of anesthesiologists and nurses. The study found that multiple perioperative, pathologic, and functional outcomes were the same regardless of whether patients were obese (BMI of 30 kg/m2 or greater) or non-obese (BMI less than 30 kg/m2).

“It is widely believed that obese patients will do worse after RALP despite a lack of data in support of this view,” Dr. Samadi observed.  “It has been suggested that RALP in patients with a high BMI is technically more challenging and may thus negatively affect perioperative and postoperative functional outcomes.”

In addition, some investigators have reported that obese patients have adverse pathologic features such as higher Gleason scores that worsen outcomes. In the new study, however, obese and non-obese subjects had similar pathologic stage, pathologic Gleason sum, positive margins, biochemical recurrence, and surgical complications of Clavien Grade 2 or higher.

Results showed that the obese and non-obese patients had comparable operating times and estimated blood loss. Additionally, 77% of non-obese and 79% of obese patients were continent three months after the procedure versus 89% and 85%, respectively, at six months, and 93% and 97% at 12 months. Patients were considered continent if they required only one pad per day or none at all.

At three months, 67% of non-obese and 62% of obese patients were potent, which increased to 76% and 74% at six months and 85% and 83% at 12 months. The investigators defined potency as a Sexual Health Inventory for Men (SHIM) score below 16 in men who were potent preoperatively (SHIM of 16 or highre). 

“Overall, our results demonstrate that RALP is an effective and safe option in patients with a high BMI,” Dr. Samadi said. “What's more, since obese patients have been shown to have worse outcomes in multiple open prostatectomy series, RALP may be a better option for patients with a high BMI.”

Dr. Samadi emphasized that because obese patients undergoing RALP may be “subjectively more surgically challenging” than non-obese patients, it is extremely imperative that a high-volume surgeon is performing the procedure. “Typically it takes me less than 90 minute to do these cases,” he said. “If you extend it beyond three hours and the surgeon doesn't have enough experience with these cases, you run the risk of DVT, blood clots in lower extremities, overall edema, and other complications.”

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