Obesity leads to a higher rate of positive surgical margins in the context of robot-assisted radical prostatectomy. Results of a prospective multicenter study

Christopher Goßler; Matthias May; Bernd Rosenhammer; Johannes Breyer; Gjoko Stojanoski; Steffen Weikert; Sebastian Lenart; Anton Ponholzer; Christina Dreissig; Maximilian Burger; Christian Gilfrich; Johannes Bründl

doi:10.5173/ceju.2020.0265.R1

Obesity leads to a higher rate of positive surgical margins in the context of robot-assisted radical prostatectomy. Results of a prospective multicenter study

Cent European J Urol. 2020;73(4):457-465. doi: 10.5173/ceju.2020.0265.R1. Epub 2020 Dec 3.

Affiliations

¹ Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
² Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany.
³ Department of Urology, Vivantes Humboldt Hospital, Berlin, Germany.
⁴ Department of Urology and Andrology, St. John of God Hospital Vienna, Brothers of Mercy Hospital, Vienna, Austria.

Abstract

Introduction: Current results concerning the effect of body mass index (BMI) on positive surgical margins (PSMs) after robot-assisted radical prostatectomy (RARP) in patients with localized prostate cancer are inconsistent. Therefore, the aim of this study was to further analyse the association between BMI and PSMs after RARP.

Material and methods: Between March 2017 and December 2017 a multicentre, prospective, randomised, single-blind series with a blinded outcome assessment of 232 RARP patients was performed. Multivariate logistical regression models were used to analyse the independent effect of obesity, with body-mass-index (BMI) dichotomised at 30 kg/m² (model-1) and at 90^th percentile (model-2), on PSMs.

Results: Median BMI was 27.2 kg/m², PSMs were found in 15.5% (n = 36). In multivariate model-1, obesity did not have a significant effect on PSMs (OR 2.34, p = 0.061). However, if BMI was dichotomized at the 90^th percentile (BMI ≥33.7 kg/m²), patients with a higher BMI showed PSMs four-times more frequently (OR 3.99, p = 0.013). In both models, preoperative prostate-specific antigen (PSA) levels and pathological tumour stage had a significant effect on PSMs. There was no significant correlation between BMI and the extent of PSMs, nor a significant difference between the BMI groups and the localisation of PSMs. There was a higher percentage of posteriolateral PSM localisation in obese patients compared to patients with a BMI of less than 30 kg/m² (58.3% and 25.3% of the localisations were posterolateral in obese and non-obese patients, respectively), however this effect was not statistically significant (p = 0.175).

Conclusions: In addition to a longer operation time and about twice as many complications, patients with a BMI of ≥33.7 kg/m² had a higher PSM rate after RARP. Differences in localization of PSMs in relation to obesity should be evaluated in future research.

Keywords: body mass index; extent of positive surgical margins; localisation of positive surgical margins; prostate cancer; radical prostatectomy; robotic surgery.

Copyright by Polish Urological Association.