Introduction and objective: Radical prostatectomy (RP) can be challenging in obese patients with body mass index (BMI) ≥ 30. The aim of the study was to evaluate and compare positive surgical margin (PSM) rate after retropubic (RRP), perineal RP (PRP) and robotic-assisted RP (RARP).
Materials and methods: Between January 2014 and April 2017 204 prostate cancer (PC) patients with BMI ≥ 30 underwent RP at our hospital (all performed by one surgeon). Patients with locally advanced PC were excluded (21 after RRP, 6 after RARP). The study comprised 177 patients with all preoperative and postoperative information available: group 1 (RRP) – 109 patients; group 2 (PRP) – 12 patients; group 3 (RARP) – 56 patients.
Results: Preoperatively, 20.2%, 25.7% and 54.1% of patients in the group 1 had low-, intermediate, and high-risk clinically localized PC (18.2%, 36.4%, 45.4% in the group 2; 32.1%, 32.1%, 35.8% in the group 3). PSM rates were 10.1%, 16.7% and 3.6% respectively (p = 0,01).
Conclusion: In our limited series of RP in patients with BMI ≥ 30, robotic-assisted approach is associated with less PSM rate compared to retropubic and perineal approaches, which could possibly result in higher biochemical recurrence-free survival and lower anxiety.
