Abstract
Objective:
To evaluate outcomes in patients with body mass index (BMI) ⩾35 kg/m2 undergoing robot-assisted radical prostatectomy (RARP), at a centre incorporating a dedicated High-Risk Preoperative Assessment Clinic (PAC) and surgical-anaesthetic multidisciplinary team (MDT) for complex patients.
Patients and Methods:
Patients with BMI ⩾35 kg/m2 (n = 50) undergoing RARP from August 2021 to July 2023 were compared to a random sample of patients with BMI <35 kg/m2 (n = 186). Patient and cancer characteristics, perioperative, oncological and continence outcomes were compared.
Results:
A higher proportion of patients with BMI ⩾35 kg/m2 were seen in High-Risk PAC and discussed in High-Risk MDT. Patients with BMI ⩾35 kg/m2 had higher operating time (206 minutes vs 190 minutes, p = 0.035), estimated blood loss (300 mL vs 200 mL, p = 0.004) and incidence of ventilatory difficulties (15% vs 2.7%, p = 0.004). Postoperatively, there was no difference in unplanned PACU (post-anaesthesia care unit) admissions, postoperative complications, length of stay, readmissions, functional or oncological outcomes.
Conclusion:
Our results support RARP as a safe and feasible option for treatment of prostate cancer in a well-selected cohort of patients with BMI ⩾35 kg/m2, in a high-volume surgical centre employing robust pre-assessment by anaesthetists with experience in high-risk cases, and joint decision-making in a surgical-anaesthetic MDT.
Level of evidence:
3
Keywords
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