Obezitenin Laparoskopik Radikal Prostatektomide Peroperatif Sonuçlara ve Kontinansa Olan Etkisi

Amaç: Laparoskopik radikal prostatektomi (LRP) cerrahisinde obezitenin cerrahi başarı, perioperatif sonuçlara ve kontinansa olan etkisinin araştırılmasıdır.Gereç ve Yöntem: Nisan 2004-Ocak 2014 tarihleri arasındaki 300 LRP uygulanan hastanın sonuçları retrospektif olarak incelendi. Yirmi hasta çalışma dışı bırakıldıktan sonra kalan 280 hasta çalışmaya alındı. Hastalar vücut kitle indeksine göre 3 gruba ayrıldılar. Grup 1: 30 kg/m2 olanlar obez olarak sınıflandırıldı. Gruplar demografik veriler, intraoperatif sonuçlar, patoloji sonucu ve kontinans durumuna göre karşılaştırıldı. Bulgular: Grup 1'de 81 hasta, grup 2'de 152 hasta, grup 3'te 47 hasta mevcuttu. Yaş ve prostat spesifik antijen sonuçlarına göre karşılaştırıldıklarında anlamlı fark bulunmadı. İntraoperatif hemogram kaybı anlamlı olarak obez grupta yüksek izlendi. Bununla birlikte tahmini kan kaybı, transfüzyon ihtiyacı, operasyon süresi, bilateral sinir koruyucu oranları ve hastanede yatış süresine göre karşılaştırıldığında sonuçları gruplar arası benzerdi. Gruplar komplikasyonlar açısından, Satava ve modifiye Clavien skorları ile karşılaştırıldığında, anlamlı fark görülmedi. Patoloji sonuçları, pozitif cerrahi sınır ve gleason skoruna göre karşılaştırıldığında anlamlı fark izlenmedi. Ameliyattan sonra 6. ayda obez grupta anlamlı olarak düşük izlenmesine rağmen, 1. yılda kontinans oranlarındaki sonuçlar benzerdi. Sonuç: LRP normal kilolu ve aşırı kilolu hastalarla karşılaştırıldığında, obez hastalara da güvenle uygulanabilir

Effects of Obesity on the Perioperative Results and Continence Status in Laparoscopic Radical Prostatectomy

Objective: To assess the effects of obesity on the surgical success and perioperative results and continence status in laparoscopic radical prostatectomy (LRP). Materials and Methods: The results of 300 consecutive patients undergoing LRP between April 2004 and January 2014 were analyzed retrospectively. Twenty patients were excluded from the study, thus, 280 patients remained. The patients were separated into 3 groups according to their body mass index. Based on this classification, group 1 (30 kg/m2) was obese. The demographic data, intraoperative results, pathological results, and states of continence were compared among the groups. Results: There were 81 patients in group 1, 152 patients in group 2, and 47 patients in group 3. There were no significant differences when the groups were compared according to age and prostate specific antigen values. The intraoperative blood loss was high in group 3 only. Moreover, the estimated blood loss, transfusion, operative time, bilateral nerve-sparing rate, hospitalization days, and complication rate were similar between the groups. There were no significant differences when the pathological results were compared according to the positive surgical margins and Gleason scores. Although the continence rates in group 3 were significantly low 6 months after the operation (p

Kaynakça

1. Erem C. Prevalence of Overweight and Obesity in Turkey. IJC Metabolic & Endocrine 2015;8:38-41.

2. Freedland SJ, Aronson WJ. Examining the relationship between obesity and prostate cancer. Rev Urol 2004;6:73-81.

3. Freedland SJ, Terris MK, Presti JC Jr, Amling CL, Kane CJ, Trock B, Aronson WJ; Search Database Study Group. Obesity and biochemical outcome following radical prostatectomy for organ confined disease with negative surgical margins. J Urol 2004;172:520-524.

4. Campeggi A, Xylinas E, Ploussard G, Ouzaid I, Fabre A, Allory Y, Vordos D, Abbou CC, Salomon L, de la Taille A. Impact of body mass index on perioperative morbidity, oncological, and functional outcomes after extraperitoneal laparoscopic radical prostatectomy. Urology 2012;80:576- 584.

5. Gözen AS, Akin Y, Özden E, Ates M, Hruza M, Rassweiler J. Impact of body mass index on outcomes of laparoscopic radical prostatectomy with longterm follow-up. Scand J Urol 2015;49:70-76.

6. Sundi D, Reese AC, Mettee LZ, Trock BJ, Pavlovich CP. Laparoscopic and robotic radical prostatectomy outcomes in obese and extremely obese men. Urology 2013;82:600-605.

7. Satava RM. Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol 2005;14:257-261.

8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. 188 Journal of Urological Surgery, 2017;4(4):183-188 Kaygısız et al. Effect of Obesity on Laparoscopic Radical Prostatectomy

9. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 2003;61:699-702.

10. Mandel P, Kretschmer A, Chandrasekar T, Nguyen HG, Buchner A, Stief CG, Tilki D. The effect of BMI on clinicopathologic and functional outcomes after open radical prostatectomy. Urol Oncol 2014;32:297-302.

11. Brown J, Rodin DM, Lee B, Dahl D. Laparoscopic Radical Prostatectomy and Body Mass Index: An Assessment of 151 Sequential Cases. J Urol 2005;173:442-445.

12. Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology 2005;65:740-744.

13. Mikhail AA, Stockton BR, Orvieto MA, Chien GW, Gong EM, Zorn KC, Brendler CB, Zagaja GP, Shalhav AL. Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology 2006;67:774-779.

14. Castle EP, Atug F, Woods M, Thomas R, Davis R. Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol 2008;26:91-95.

15. Gu X, Araki M, Wong C. Does elevated body mass index (BMI) affect the clinical outcomes of robot-assisted laparoscopic prostatectomy (RALP): a prospective cohort study. Int J Surg 2014;12:1055-1060.

16. Eden CG, Chang CM, Gianduzzo T, Moon DA. The impact of obesity on laparoscopic radical prostatectomy. BJU Int 2006;98:1279-1282.

17. Kim MJ, Park SY, Rha KH. Influence of prostate weight, obesity and height on surgical outcomes of robot-assisted laparoscopic radical prostatectomy in Korean men. J Robotic Surg 2008;1:287-290.

18. Amling CL, Kane CJ, Riffenburgh RH, Ward JF, Roberts JL, Lance RS, Friedrichs PA, Moul JW. Relationship between obesity and race in predicting adverse pathologic variables in patients undergoing radical prostatectomy. Urology 2001;58:723-728.

19. Mitchell CR, Umbreit EC, Rangel LJ, Bergstralh EJ, Karnes RJ. Does Body Mass Index “Dilute” the Predictive Property of Prostate-specific Antigen for Tumor Volume at Radical Prostatectomy? Urology 2011;4:868-872.

20. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003;348:1625-1638.

21. Morote J, Celma A, Planas J, Placer J, Konstantinidis C, Iztueta I, de Torres IM, Oliván M, Reventós J, Doll Al. Sedentarism and overweight as risk factors for the detection of prostate cancer and its aggressiveness. Actas Urol Esp 2014;38:232-237.

22. De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes 2013;2013:291546.

23. Gong Z, Agalliu I, Lin DW, Stanford JL, Kristal AR. Obesity is associated with increased risks of prostate cancer metastasis and death after initial cancer diagnosis in middle-aged men. Cancer 2007;109:1192-1202.

24. Parker AS, Thiel DD, Bergstralh E, Carlson RE, Rangel LJ, Joseph RW, Diehl N, Karnes RJ. Obese men have more advanced and more aggressive prostate cancer at time of surgery than non-obese men after adjusting for screening PSA level and age: results from two independent nested case–control studies. Prostate Cancer Prostatic Dis 2013;16:352-356.

25. Hanks GE. External beam radiation therapy for clinically localized prostate cancer: patterns of care studies in the United States. NCI Monogr 1988:75- 84.

26. Sugaya K, Oda M, Nishijima S, Shimabukuro S, Ashimine S, Sunabe T, Shimabukuro H, Goya M, Kagawa H, Yonoh H, Shiroma K, Miyazato T, Koyama Y, Hatano T, Ogawa Y, Owan T. Risk factors for duration of urinary incontinence after radical prostatectomy. Nihon Hinyokika Gakkai Zasshi 2002;93:444-449.

27. Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA. Graefen M, Guazzoni G, Menon M, Mottrie A, Patel VR, Van der Poel H, Rosen RC, Tewari AK, Wilson TG, Zattoni F, Montorsi F. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 2012;62:418-430.

28. Wiltz AL, Shikanov S, Eggener SE, Katz MH, Thong AE, Steinberg GD, Shalhav AL, Zagaja GP, Zorn KC. Robotic radical prostatectomy in overweight and obese patients: oncological and validated functional outcomes. Urology 2009;73:316-322.

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