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The following is a summary of “Perioperative, functional, and oncologic outcomes in obese patients undergoing Da Vinci robot-assisted radical prostatectomy: a systematic review and meta-analysis,” published in the September 2024 issue of Urology by Wang et al.

Researchers conducted a retrospective study to compare the perioperative, functional, and oncologic outcomes of robot-assisted radical prostatectomy (RARP) in patients with obese (OB) and non-obese (NOB) prostate cancer. 

They systematically searched databases for relevant studies published in English until September 2023. To analyze various parameters, a review manager was utilized. The study is registered with PROSPERO (CRD42023473136), and a total of 16 comparative studies involving 8,434 patients with OB were analyzed against 55,266 NOB. 

The results showed that the OB group experienced a longer operative time (WMD 17.8 min, 95% CI 9.7, 25.8; P<0.0001), a longer length of hospital stay (WMD 0.18 day, 95% CI 0.12, 0.24; P<0.00001), and a higher estimated blood loss (WMD 50.6 ml, 95% CI 11.7, 89.6; P=0.01). They also had a higher pelvic lymphadenectomy rate (RR 1.08, 95% CI 1.04, 1.12; P<0.0001) and a lower nerve-sparing rate (RR 0.95, 95% CI 0.91, 0.99; P<0.01). No differences were found in unilateral (RR 1.0, 95% CI 0.8, 1.3; P=0.8) or bilateral (RR 0.9, 95% CI 0.9, 1.0; P=0.06) nerve-sparing rates. Complication rates (RR 1.6, 95% CI 1.5, 1.7; P<0.00001) were also higher in the OB group, with major (RR 1.4, 95% CI 1.1, 1.8; P=0.01) and minor (RR 1.4, 95% CI 1.1, 1.7; P<0.01) complications elevated. Increased probabilities were seen in patients with OB of incontinence (RR 1.17, 95% CI 1.03, 1.33; P=0.01) and impotency (RR 1.08, 95% CI 1.01, 1.15; P=0.02) at 1 year and the positive surgical margin (RR 1.2, 95% CI 1.1, 1.3; P<0.01) was higher in the OB group. 

Investigators concluded that poorer perioperative and oncologic outcomes in the obese group suggested weight loss before surgery might improve patient prognosis. 

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01595-5#Abs1