Introduction and Objective: There is a possible association between obesity and unfavorable prostate cancer (PC). It has been shown that obese patients are less likely to undergo radical surgery and more often have suboptimal perioperative and functional results after radical prostatectomy (RP). In theory, robotic and perineal approaches may have advantages in this group of patients, although there is a clear lack of comparative studies on this issue. The aim of our study was to investigate positive surgical margins (PSM) rate after retropubic RP (RRP), robotic-assisted RP (RARP) and perineal RP (PRP) performed by a single surgeon.
Methods: We reviewed our database of 702 patients treated with RP between January 2014 and October 2017, of which 236 patients had BMI ≥ 30. Obese patients with clinically localized PC were included while patients with a locally advanced PC were excluded (22 after RRP and 8 after RARP). The study groups comprised 109 patients after RRP (group 1), 67 after RARP (group 2) and 23 after PRP (group 3). Nerve-sparing technique was used more often in RARP group compared to RRP and PRP groups (52,2% vs 34,5% vs 8,7%, p < 0.01).
Results: PSM rate in obese patients was significantly lower after RARP compared to RRP and PRP (p < 0.01). PSM localization in group 1 (RRP): bladder neck - 3 (2,6%); posterolateral area - 3 (2,6%); apex -7 (6%). PSM localization in group 2 (RARP): bladder neck - 1 (1,5%); posterolateral area - 1 (1,5%); apex - 1 (1,5%). PSM localization in group 3 (PRP): bladder neck - 1 (4,4%); posterolateral area - 3 (13%). Wound complications were noticed in 6 (5,2%) patients in group 1 (RRP), 1 (4,4%) patient in group 3 (PRP) and none in group 2 (RARP).
Conclusions: According to our experience, RARP is associated with lower PSM rate, which could possibly improve oncological outcomes (however, this statement should be confirmed by further follow-up), reduce anxiety and fruequency of potentially harmful adjuvant treatment. Limitations of our study include small number of observations in the PRP group and lack of randomization.