Background:The growing prevalence of obesity, particularly morbid obesity (BMI > 40 kg/m2), presents unique challenges in surgical management. In robotic-assisted radical prostatectomy (RARP) for prostate cancer, morbid obesity is associated with longer operative times, increased blood loss, and complex nerve-sparing procedures. These challenges may impact functional and oncological outcomes, making it essential to understand how high BMI affects RARP results. However, data on outcomes for patients with morbid obesity remain limited.Methods:We retrospectively reviewed 14,444 patients who underwent RARP by a single surgeon from 2008 to 2023. A total of 183 patients with morbid obesity (BMI > 40 kg/m2) were matched 1:1 with 183 normal-weight patients (BMI 18.5–24.9 kg/m2) using propensity-score matching based on age, PSA levels, clinical staging, ISUP grade, comorbidities, and baseline urinary and sexual function scores. We compared perioperative variables, complications, and oncological and functional outcomes between groups.Results:Patients with morbid obesity had longer console times (median 90 vs. 75 min,p< 0.001) and higher rates of estimated blood loss over 100 mL (39% vs. 22%,p= 0.001). Full nerve-sparing was less frequent in this group (16.9% vs. 38.8%,p< 0.001), and postoperative lymphocele formation rates were higher (12.7% vs. 6.0%,p= 0.021). While patients with morbid obesity demonstrated a higher incidence of pT3a disease (34.4% vs. 20.2%,p= 0.015), no significant differences were observed in BCR and PSM (24% vs. 18%,p= 0.25) or functional outcomes, such as potency and urinary continence, at 12 and 24 months after operation.Conclusions:RARP in patients with morbid obesity is safe and feasible, with low rates of complications and no observed differences in functional and oncological outcomes compared to normal-weight patients. Further studies are needed to assess long-term outcomes in this growing patient population.
背景：肥胖症，特别是病态肥胖（BMI > 40 kg/m²）的患病率日益增加，给外科治疗带来了独特的挑战。在前列腺癌的机器人辅助根治性前列腺切除术（RARP）中，病态肥胖与更长的手术时间、更多的失血量以及复杂的神经保留手术相关。这些挑战可能影响功能性和肿瘤学结果，因此理解高BMI如何影响RARP的结果至关重要。然而，关于病态肥胖患者结果的数据仍然有限。 方法：我们回顾性分析了2008年至2023年间由同一位外科医生进行的14,444例RARP患者。通过基于年龄、PSA水平、临床分期、ISUP分级、合并症以及基线排尿和性功能评分的倾向评分匹配，将183名病态肥胖患者（BMI > 40 kg/m²）与183名正常体重患者（BMI 18.5–24.9 kg/m²）按1:1进行匹配。我们比较了两组间的围手术期变量、并发症以及肿瘤学和功能结果。 结果：病态肥胖患者具有更长的控制台时间（中位数90分钟 vs. 75分钟，p < 0.001）和更高的估计失血量超过100 mL的比例（39% vs. 22%，p = 0.001）。该组患者中完全神经保留的频率较低（16.9% vs. 38.8%，p < 0.001），术后淋巴囊肿形成率较高（12.7% vs. 6.0%，p = 0.021）。虽然病态肥胖患者表现出更高的pT3a期疾病发生率（34.4% vs. 20.2%，p = 0.015），但在术后12个月和24个月时，两组在BCR和PSM（24% vs. 18%，p = 0.25）或功能结果（如勃起功能和尿控）方面未观察到显著差异。 结论：对于病态肥胖患者，RARP是安全可行的，并发症发生率低，并且与正常体重患者相比，在功能和肿瘤学结果方面未观察到差异。需要进一步的研究来评估这一不断增长的患者群体的长期结果。
肿瘤(癌症)患者之家