Obezitenin ekstraperitoneal laparoskopik radikal prostatektomi sonuçlarına etkisi

Öz

Amaç: Bu çalışmada obezitenin ekstraperitoneal laparoskopik radikal prostatektomi (LRP) yapılan hastalarda perioperatif ve fonksiyonel sonuçlara etkisini değerlendirmeyi amaçladık.
Gereç ve yöntem: Etik kurul onayı alındıktan sonra Nisan 2014-Haziran 2018 tarihleri arasında lokalize prostat kanseri nedeniyle ekstraperitoneal LRP yapılan hastaların verileri retrospektif olarak incelendi. Takip süresi 12 aydan kısa olan, takipten çıkan, preoperatif hormonoterapi alan, pelvik cerrahi veya radyoterapi öyküsü olan ve verileri eksik olan hastalar çalışma dışı bırakıldı. Hastaların demografik dataları, perioperatif bulgular, patoloji sonuçları ve takiplerdeki onkolojik ve fonksiyonel sonuçlar kaydedildi. VKİ ≥30 kg/m² olan hastalar obez gruba dahil edildi.
Bulgular: Çalışmaya toplamda 160 hasta dahil edildi. Obez grubunda 64 hasta, obez olmayan grupta ise 96 hasta mevcuttu. Obez grubundaki 64 hastanın yaş ortalaması 66,06±5,6, obez olmayan gruptaki 96 hastanın yaş ortalaması ise 66,74±5,2 idi. Preoperatif IIEF skorları obez hasta grubunda anlamlı olarak daha düşüktü. Her iki grup, yaş, PSA, CCI, biyopsi GS, klinik evre, intraoperatif ve postoperatif komplikasyonlar açısından benzer özelliklere sahipti. Ayrıca iki grup, postoperatif onkolojik sonuçlar, biyokimyasal rekürrens, kontinans ve IIEF skorlarındaki düşüş açısından karşılaştırıldığında anlamlı fark gözlenmedi.
Sonuç: Prostat kanserli obez hastalarda ekstraperitoneal LRP, benzer onkolojik ve fonksiyonel sonuçlarla uygulanabilen, güvenli ve etkili bir tedavi metodu olarak görünmektedir.

Anahtar Kelimeler

• Prostat kanseri
• ekstraperitoneal yaklaşım
• laparoskopik radikal prostatektomi
• obezite

The impact of obesity on the outcomes of extraperitoneal laparoscopic radical prostatectomy

Öz

Objective: In this study, we aimed to evaluate the impact of obesity on perioperative and functional outcomes in patients who underwent extraperitoneal LRP.
Material and methods: After the approval of the ethics committee, the data of patients who underwent extraperitoneal LRP between April 2014 and June 2018 for localized prostate cancer were analyzed retrospectively. Patients with follow-up period of less than 12 months, who were out of follow-up, who received preoperative hormonal therapy, who had a history of pelvic surgery or radiotherapy, and whose data were missing were excluded from the study. Demographic data, perioperative findings, pathology results and oncological and functional results in follow-up were recorded. Patients with BMI ≥30 kg/m² were included in the obese group.
Results: A total of 160 patients were included in the study. There were 64 patients in the obese group and 96 patients in the non-obese group. The mean age of 64 patients in the obese group was 66.06±5.6, and the mean age of 96 patients in the non-obese group was 66.74±5.2. Preoperative IIEF scores were significantly lower in the obese patient group. Both groups had similar characteristics in terms of age, PSA, CCI, biopsy GS, clinical stage, intraoperative and postoperative complications. In addition, when the two groups were compared in terms of postoperative oncological outcomes, biochemical recurrence, continence, and decrease in IIEF scores, no significant difference was observed.
Conclusions: LRP seemed safe and effective in obese patients, with similar onncological outcomes, functional outcomes, complication rates and continence rates to normal weight patients.

Anahtar Kelimeler

• Prostat cancer
• extraperitoneal approach
• laparoscopic radical prostatectomy
• obesity

Kaynakça

1. 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6):394–424. DOI: 10.3322/caac.21492.
2. 2. Wild CP, Weiderpass E, Stewart BW. World cancer report: cancer research for cancer prevention. International Agency for Research on Cancer, Lyon. 2020.
3. 3. Agalliu I, Lin, WJ, Zhang, JS, Jacobson JS, Rohan TE, Adusei B, et al. Overall and central obesity and prostate cancer risk in African men. Cancer Causes Control. 2022; 33, 223–239. DOI: 10.1007/s10552-021-01515-0
4. 4. Vidal AC, Howard LE, Moreira DM, Castro-Santamaria R, Andriole GL Jr, Freedland SJ. Obesity increases the risk for high-grade prostate cancer: results from the REDUCE study. Cancer Epidemiol Biomarkers Prev 2014;23(12):2936-42. DOI: 10.1158/1055-9965.EPI-14-0795
5. 5. Wei Y, Wu YP, Lin MY, Chen SH, Lin YZ, Li XD,et al. Impact of Obesity on Long-Term Urinary Incontinence after Radical Prostatectomy: A Meta-Analysis. Biomed Res Int 2018:8279523. DOI: 10.1155/2018/8279523
6. 6. Özseven L, Sönmez Y. Prevalence of the metabolic syndrome among adults in a family health center in Turkey. SDÜ Tıp Fakültesi Dergisi. 2012; 19(1): 6-11. https://dergipark.org.tr/en/download/article-file/196914
7. 7. Eggleston JC, Walsh PC. Radical prostatectomy with preservation of sexual function: pathological findings in the first 100 cases. J Urol 1985;134(6):1146–1148. DOI: 10.1016/s0022-5347(17)47661-0
8. 8. Yıldız A, Anıl H, Akdemir S, Aksaray EE, Ateş M, Arslan M. Extraperitoneal Laparoscopic Versus Transperitoneal Robot-Assisted Laparoscopic Approaches for Extended Pelvic Lymph Node Dissection During Radical Prostatectomy. J Laparoendosc Adv Surg Tech A. 2022 Apr;32(4):355-359. DOI: 10.1089/lap.2021.0174

9. 9. Nguyen, NT, Ho HS, Fleming NW, Moore P, Lee SJ, Goldman CD, et al. Cardiac function during laparoscopic vs open gastric bypass. Surg Endosc. 2002; 16:78-83. DOI: 10.1007/s00464-001-8159-x
10. 10. Brown JA, Rodin DM, Lee B, Dahl DM. Laparoscopic radical prostatectomy and body mass index: an assessment of 151 sequential cases. J Urol. 2005;173(2):442-5. DOI: 10.1097/01.ju.0000148865.89309.cb
11. 11. Eden CG, King D, Kooiman GG, Adams TH, Sullivan ME, Vass JA. Transperitoneal or extraperitoneal laparoscopic radical prostatectomy: does the approach matter? J Urol 2004;172(6 pt 1):2218–23. DOI: 10.1097/01.ju.0000144640.26182.41
12. 12. Seo MH, Kim YH, Han K, Jung JH, Park YG, Lee SS et al. Prevalence of Obesity and Incidence of Obesity-Related Comorbidities in Koreans Based on National Health Insurance Service Health Checkup Data 2006-2015. J Obes Metab Syndr. 2018;27(1):46-52. DOI: 10.7570/jomes.2018.27.1.46
13. 13. Gözen AS, Akin Y, Özden E, Ates M, Hruza M, Rassweiler J. Impact of body mass index on outcomes of laparoscopic radical prostatectomy with long-term follow-up. Scand J Urol. 2015;49(1):70-6. DOI: 10.3109/21681805.2014.920416
14. 14. Singh A, Fagin R, Shah G, Shekarriz B. Impact of prostate size and body mass index on perioperative morbidity after laparoscopic radical prostatectomy. J Urol. 2005;173(2):552-4. DOI: 10.1097/01.ju.0000150101.95236.35
15. 15. Eden CG, Chang CM, Gianduzzo T, Moon DA. The impact of obesity on laparoscopic radical prostatectomy. BJU Int. 2006;98(6):1279-82. DOI: 10.1111/j.1464-410X.2006.06443.x
16. 16. Zhang X, Zhou G, Sun B, Zhao G, Liu D, Sun J et al. Impact of obesity upon prostate cancer-associated mortality: a meta-analysis of 17 cohort studies. Oncol Lett. 2015;9(3):1307–1312. DOI: 10.3892/ol.2014.2841
17. 17. Morote J, Celma A, Planas J, Placer J, Konstantinidis C, Iztueta I, et al. Sedentarism and overweight as risk factors for the detection of prostate cancer and its aggressiveness. Actas Urol Esp 2014;38:232–7. DOI: 10.1016/j.acuro.2013.09.001
18. 18. Han H, Cao Z, Qin Y, Wei X, Ruan Y, Cao Y, et al. Morbid obesity is adversely associated with perioperative outcomes in patients undergoing robot-assisted laparoscopic radical prostatectomy. Can Urol Assoc J. 2020;14(11):E574-E581. DOI: 10.5489/cuaj.6389
19. 19. Wang K, Zhuang Q, Xu R, Lu H, Song G, Wang J et al. Transperitoneal versus extraperitoneal approach in laparoscopic radical prostatectomy: A meta-analysis. Medicine (Baltimore) 2018;97(29):e11176. DOI: 10.1097/MD.0000000000011176
20. 20. Wiltz AL, Shikanov S, Eggener SE, Katz MH, Thong AE, Steinberg GD,et al. Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes. Urology. 2009;73(2):316-22. DOI: 10.1016/j.urology.2008.08.493
21. 21. Castle EP, Atug F, Woods M, Thomas R, Davis RT. Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol. 2008;26:91-95. DOI: 10.1007/s00345-007-0217-0
22. 22. Yu YD, Byun SS, Lee SE, Hong SK. Impact of Body Mass Index on Oncological Outcomes of Prostate Cancer Patients after Radical Prostatectomy. Sci Rep. 2018;8(1):11962. DOI: 10.1038/s41598-018-30473-y
23. 23. Kok DE, van Roermund JG, Aben KK, van de Luijtgaarden MW, Karthaus HF, van Vierssen Trip OB, et al. Body mass index is not a predictor of biochemical recurrence after radical prostatectomy in Dutch men diagnosed with prostate cancer. World J Urol 2011;29:695–701. DOI: 10.1007/s00345-010-0629-0
24. 24. Wolin KY, Luly J, Sutcliffe S, Andriole GL, Kibel AS. Risk of urinary incontinence following prostatectomy: the role of physical activity and obesity. J Urol. 2010;183(2):629-33. DOI: 10.1016/j.juro.2009.09.082
25. 25. Mao Q, Lin Y, Chen H, Bai Y, Qin J, Zheng X, et al. Preoperative risk factors for early postoperative urinary continence recovery after non-nerve-sparing radical prostatectomy in Chinese patients: a single institute retrospective analysis. Int J Clin Exp Med. 2015;8(8):14105-9. PMCID: PMC4613062
26. 26. Mulholland TL, Huynh PN, Huang RR, Wong C, Diokno AC, Peters KM. Urinary incontinence after radical retropubic prostatectomy is not related to patient body mass index. Prostate Cancer Prostatic Dis. 2006;9(2):153-9. DOI: 10.1038/sj.pcan.4500860
27. 27. Kadono Y, Ueno S, Kadomoto S, Iwamoto H, Takezawa Y, Nakashima K, et al. Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: Nerve-sparing technique contributes to the reduction of postprostatectomy incontinence. Neurourol Urodyn. 2016;35(8):1034-1039. DOI: 10.1002/nau.22877
28. 28. Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology. 2005;65(4):740-4. DOI: 10.1016/j.urology.2004.10.061