肥胖對攝護腺癌行達文西輔助攝護腺根除性切除之影響
董牧喬¹、吳俊賢^1,4,5,6、吳振宇^1,4、郭威廷^1,5,6、李彥羲^2,5,6、

蔡佳龍³、麥倖嘉¹、賴建名¹、陳思翰¹、林嘉祥^1,4
1義大醫院泌尿科；²義大癌治療醫院泌尿科；³義大大昌醫院泌尿科；⁴義守大學護理學系；

⁵義守大學生物技術與化學工程研究所；⁶義守大學醫學系
Impact of Obesity on the Outcome of Prostate Cancer post Robot-Assisted Radical Prostatectomy
Mu-Chiao Tung ¹, Chun-Hsien Wu ^1,4,5,6, Richard C. Wu^1,4, Wade Wei-Ting Kuo^1,5,6,

Yen-Hsi, Lee ^2,5,6、Chia-Lung Tsai ³ Hsing-Chia Mai¹,

Jian-Min Lai¹, Sih-Han Chen¹, Victor C. Lin ^1,6

¹ Department of Urology, E-DA Hospital, Kaohsiung, Taiwan

² Department of Urology, E-DA Cancer Hospital, Kaohsiung, Taiwan

³ Department of Urology, E-DA Dachang Hospital, Kaohsiung, Taiwan

⁴ Department of Nursing, I-Shou University, Kaohsiung, Taiwan

⁵ Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan

⁶ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan

Purpose:

Obesity, one of the major health problems in modern society, had been proven to increase surgical difficulty and influence the outcomes in open radical prostatectomy. However, the relationship between obesity and the outcome of robot-assisted radical prostatectomy (RaRP) were not conclusive. Thus, the purpose of this study was to investigate the impact of obesity on the peri-operative outcomes of RaRP.

Materials and Methods:

We retrospectively analyzed 164 patients who underwent RaRP at our hospital by single experienced surgeon from April, 2016 to January, 2021. Obesity was evaluated by body mass index (BMI) and waist circumference (WC). BMI was categorized into three groups (Normal: BMI<24 kg/m2, overweight: BMI between 24 kg/m2 and 27 kg/m2, and obese: BMI>27 kg/m2 according to standard of Taiwan National Health Institute). WC was acquired by measuring the pre-operative magnetic resonance image (MRI) and categorized into two groups (Normal: WC< 90cm, Central Obesity: WC > 90cm). Functional outcomes included 1-year post-operative erectile function assessed by erectile function score and 1-month post-operative continence status assessed by pad use per day. Peri-operative outcomes collected as continuous variables were analyzed by Kruskal Kruskal-Wallis test and Mann-Whitney U test. Other peri-operative outcomes and functional outcomes were collected as categorical variables and analyzed by Chi-Square test.

Results:

Of the 164 patients included in this study, 46 patients (28%) had normal BMI; 68 patients (41.4%) were overweight; 50 patients (30.5%) were obese. From our analysis, only port-time showed significant difference in different BMI groups (Median port time in normal, overweight, and obese group: 31, 33 and 40 minutes respectively, p=0.02). The other peri-operative outcomes showed no significant difference. For functional outcomes, 1-year post-operative erectile function status showed no significant difference [Normal group: 7/39 (17.9%), Overweight group: 14/54 (25.9%), Obese group: 6/38 (15.8%) were potent, p=0.44]. Neither did the 1-month post-operative continence status showed significant difference [Normal group: 43/45 (95.6%), Overweight group: 64/67 (95.5%), Obese group: 47/49 (95.9%) were urinary continent, p=0.99]. Of the 164 patients, 142 patients had available MRI image at our hospital and WC was acquired. 107 patients had normal WC (75.4%) and 35 patients had central obesity (24.6%). When analyzed by WC, there were no significant difference in all peri-operative and functional outcomes. However, there seemed to be a trend of more blood loss in central obese group (Median blood loss: 200ml versus 250ml, p=0.074).

Conclusion:

Our results suggested that obesity only contributed to longer port time. Such information could alter patient’s decision on surgical method, especially those patients with overweight or obese status. In addition, larger-scaled studies are needed to further investigate the relationship between central obesity and the outcome of RaRP.