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Obesity and capsular incision at the time of open retropubic radical prostatectomy.
J Urol 2005; 174(5):1798-801; discussion 1801JU

Abstract

PURPOSE

The goal of radical prostatectomy (RP) is complete removal of the intact prostate. Obese men can represent a technical challenge. However, to our knowledge objective data linking obesity with technically inferior surgery are lacking. Therefore, we examined the association between body mass index (BMI) and capsular incision at RP as a surrogate of a poor technical operation in men treated for prostate cancer by several high volume surgeons at a center of excellence.

MATERIALS AND METHODS

The study population consisted of 7,027 men treated with anatomical retropubic RP between 1996 and 2004 by 7 high volume surgeons. We evaluated the association between BMI and capsular incision using logistic regression, adjusting for clinical and pathological variables, and for the surgeon.

RESULTS

Overall capsular incision was noted in 4.6% of all RP specimens. After adjustment for preoperative prostate specific antigen, patient race, height, year of surgery, clinical stage, pathological Gleason sum, prostate weight, extraprostatic extension and seminal vesicle invasion increased BMI was associated with increased odds of capsular incision (p trend = 0.005). After further adjustment for surgeon mild obesity was associated with 30% increased odds of capsular incision (OR 1.30, 95% CI 0.92 to 1.83), while moderate and severe obesity was associated with 57% increased odds of capsular incision (OR 1.57, 95% CI 0.82 to 3.00) relative to normal weight men (p trend = 0.06).

CONCLUSIONS

In a study of more than 7,000 men treated by 7 experienced surgeons BMI was positively related to capsular incision. This suggests that open retropubic RP is technically more difficult in obese men, which results in a greater likelihood of a less than technically ideal operation. Although this may be predicted to have a negative impact on disease-free survival outcomes in obese men, it is unlikely to alone explain the worse outcomes in obese men noted in previous RP series.

Authors+Show Affiliations

The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland 21287-2101, USA. sfreedl1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16217290

Citation

Freedland, Stephen J., et al. "Obesity and Capsular Incision at the Time of Open Retropubic Radical Prostatectomy." The Journal of Urology, vol. 174, no. 5, 2005, pp. 1798-801; discussion 1801.
Freedland SJ, Grubb KA, Yiu SK, et al. Obesity and capsular incision at the time of open retropubic radical prostatectomy. J Urol. 2005;174(5):1798-801; discussion 1801.
Freedland, S. J., Grubb, K. A., Yiu, S. K., Nielsen, M. E., Mangold, L. A., Isaacs, W. B., ... Partin, A. W. (2005). Obesity and capsular incision at the time of open retropubic radical prostatectomy. The Journal of Urology, 174(5), pp. 1798-801; discussion 1801.
Freedland SJ, et al. Obesity and Capsular Incision at the Time of Open Retropubic Radical Prostatectomy. J Urol. 2005;174(5):1798-801; discussion 1801. PubMed PMID: 16217290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obesity and capsular incision at the time of open retropubic radical prostatectomy. AU - Freedland,Stephen J, AU - Grubb,Kelly A, AU - Yiu,Sindy K, AU - Nielsen,Matthew E, AU - Mangold,Leslie A, AU - Isaacs,William B, AU - Epstein,Jonathan I, AU - Partin,Alan W, PY - 2005/10/12/pubmed PY - 2005/11/16/medline PY - 2005/10/12/entrez SP - 1798-801; discussion 1801 JF - The Journal of urology JO - J. Urol. VL - 174 IS - 5 N2 - PURPOSE: The goal of radical prostatectomy (RP) is complete removal of the intact prostate. Obese men can represent a technical challenge. However, to our knowledge objective data linking obesity with technically inferior surgery are lacking. Therefore, we examined the association between body mass index (BMI) and capsular incision at RP as a surrogate of a poor technical operation in men treated for prostate cancer by several high volume surgeons at a center of excellence. MATERIALS AND METHODS: The study population consisted of 7,027 men treated with anatomical retropubic RP between 1996 and 2004 by 7 high volume surgeons. We evaluated the association between BMI and capsular incision using logistic regression, adjusting for clinical and pathological variables, and for the surgeon. RESULTS: Overall capsular incision was noted in 4.6% of all RP specimens. After adjustment for preoperative prostate specific antigen, patient race, height, year of surgery, clinical stage, pathological Gleason sum, prostate weight, extraprostatic extension and seminal vesicle invasion increased BMI was associated with increased odds of capsular incision (p trend = 0.005). After further adjustment for surgeon mild obesity was associated with 30% increased odds of capsular incision (OR 1.30, 95% CI 0.92 to 1.83), while moderate and severe obesity was associated with 57% increased odds of capsular incision (OR 1.57, 95% CI 0.82 to 3.00) relative to normal weight men (p trend = 0.06). CONCLUSIONS: In a study of more than 7,000 men treated by 7 experienced surgeons BMI was positively related to capsular incision. This suggests that open retropubic RP is technically more difficult in obese men, which results in a greater likelihood of a less than technically ideal operation. Although this may be predicted to have a negative impact on disease-free survival outcomes in obese men, it is unlikely to alone explain the worse outcomes in obese men noted in previous RP series. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/16217290/Obesity_and_capsular_incision_at_the_time_of_open_retropubic_radical_prostatectomy_ L2 - https://www.jurology.com/doi/full/10.1097/01.ju.0000177077.53037.72?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -