Complication Risk Due to Obesity Greater With Minimal Invasive RP
Obesity predicts a wider range of complications in PCa patients who undergo laparoscopic or robot-assisted versus open radical prostatectomy.
Obesity has a greater influence on 30-day complication rates following minimally invasive prostatectomy (MIP) versus open surgery for prostate cancer (PCa), according to a new report.
In a study based on 17,693 minimally invasive prostatectomy (MIP) and 4674 open radical prostatectomy procedures nationwide, class I (body mass index [BMI] 30 to 34.9 kg/m2), II (BMI 35- 39.9 kg/m2), and III (BMI above 40 kg/m2) obesity accounted for 25%, 7%, and 2.3% of the population, respectively.
Perioperative complication rates overall were higher after open than minimally invasive surgery (19 vs 5.3%), across BMI classes, Scott Johnson, MD, and colleagues from the University of Chicago, reported in Urology. The open approach was associated with 4.5 time higher odds of any complication compared with any obesity class. The findings add to evidence supporting minimally invasive procedures in general.
For men who had laparoscopic or robot-assisted surgery, increasing BMI influenced rates of a range of complications, including wound, renal, thromboembolic, infectious, neurologic, Clavien grade III to V, and others. Obesity was associated only with wound and renal complications after open RP.
“This stresses the fact that operative challenges for obese patients are not completely overcome by minimally invasive approaches, highlighted by multiple reports of inferior outcomes following MIP in obese patients,” Dr Johnson and his team explained. They acknowledged that disease characteristics were lacking in the database, so they could not assess how PCa grade and stage related to surgical outcomes.
Obesity independently predicted only wound, renal, and thromboembolic complications, in multivariable analyses. Wound complications increased with greater BMI, in agreement with results from prior studies.
Wound complications related more strongly to the open approach than BMI. “Open surgery may lead to more frequent wound problems as a result of local tissue trauma from larger incisions and mechanical retraction of the surgical site, as has been shown in a number of surgical procedures, including radical prostatectomy,” Dr Johnson and colleagues explained.
Using an interaction model, the investigators further determined that obesity status was not a strong influencer of complications by surgical approach in most cases. Overweight status had no bearing.
1. 1. Johnson SC, Packiam VT, Golan S, Cohen AJ, Nottingham CU, and Smith ND. The Effect of Obesity on Perioperative Outcomes for Open and Minimally Invasive Prostatectomy. Urology. doi: 10.1016/j.urology.2016.11.028.