Impact of Body Mass Index on Perioperative Morbidity, Oncological, and Functional Outcomes After Extraperitoneal Laparoscopic Radical Prostatectomy

Objective To evaluate the impact of obesity on the outcomes of laparoscopic radical prostatectomy. Methods and Materials In a prospective urologic cancer database, 765 patients underwent extraperitoneal laparoscopic radical prostatectomy for localized prostate cancer. The patients were categorized into 3 groups of body mass index (kg/m 2 ): 30.0 (n = 124, 16%, “obese”). We assessed the perioperative, oncological, and functional outcomes in this cohort of patients. Preoperative and postoperative evaluation of continence and erectile function were performed using validated questionnaires. Results Mean operative time was significantly longer in obese patients ( P P P = .002) and Gleason score ≥7 (80%, P = .005). The obese group had the higher positive surgical margins rate (overall: 27%, P = .012; pT2: 20%, P = .02). With a mean follow-up of 38 months, obesity was not an independent predictive factor of biochemical recurrence. At the 12-month follow-up, 85%, 74%, and 72% of normal, overweight, and obese men, respectively, were continent (no pad) ( P = .04). At the 12-month follow-up, 57%, 58%, and 40% of normal, overweight, and obese men, respectively, reported an erection sufficient for intercourse ( P = .01). Conclusion Laparoscopic radical prostatectomy is a safe and effective procedure in obese men with midterm cancer control. However, obese patients are at higher risk of aggressive disease. Recovery of continence and potency in these patients are significantly lower compared to nonobese men.