Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Obez ve Nonobez Hastalarda Robot Yardımlı Radikal Prostatektomi Sonuçlarının Karşılaştırılması
Comparison of Robot Assisted Radical Prostatectomy Results in Obese and Non-obese Patients
Murat TÜKENa, Mithat EKŞİa, Osman ÖZDEMİRa, Yusuf ARIKANa, Deniz NOYAN ÖZLÜa, Yunus ÇOLAKOĞLUa, İsmail EVRENa, Selçuk ŞAHİNa, Volkan TUĞCUa, Ali İhsan TAŞÇIa
aÜroloji Kliniği, Sağlık Bilimleri Üniversitesi Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
J Reconstr Urol. 2019;9(3):89-94
doi: 10.5336/urology.2019-71560
Article Language: TR
Full Text
ÖZET
 Amaç: Prostat kanseri ve obezite ilişkisi üzerine yapılan birçok çalışmada, obezite ve artan adipozitenin radikal prostatektomi sonrası daha kötü patolojik, onkolojik ve fonksiyonel sonuçlar ile ilişkili olduğu bulunmuştur. Sürekli artan prostat kanseri insidansı ve obezite oranları düşünüldüğünde, hekimler, prostat kanserine sahip obez hastaların zorlu cerrahi yönetimi ile artan sıklıkla karşı karşıya kalmaktadır. Biz de bu çalışmamızda, prostat kanseri sebebiyle robot yardımlı radikal prostatektomi [robot-assissted radical prostatectomy (RARP)] yapılan obez ve nonobez hastaların verilerini karşılaştırmayı ve obezitenin cerrahi sonuçlar üzerindeki etkisini incelemeyi hedefledik. Gereç ve Yöntemler: Ocak 2016-Ocak 2018 yılları arasında, lokalize prostat kanseri sebebiyle uygulanan RARP operasyonuna ait veriler incelendi. Hastalara ait demografik, preoperatif, peroperatif ve postoperatif veriler kaydedildi. Postoperatif 3, 6 ve 12. ayda IIEF skorları, ayrıca postoperatif sonda çekilmesi sonrasında ve 3, 6, 9 ve 12. ayda kontinans durumları sorgulandı. Hastalar beden kitle indeksi (BKİ) skorlarına göre nonobez (Grup 1: <30 kg/m2), obez (Grup 2: >30 kg/m2) olarak 2 gruba ayrıldı ve sonuçlar karşılaştırıldı. Bulgular: RARP yapılan nonobez 73 ve obez 40 hasta çalışmaya dâhil edildi. Ortalama yaş Grup 1 ve Grup 2 için sırasıyla 60,7±5,9 ve 60,3±5,5 olarak tespit edildi ve 2 grup arasında anlamlı fark izlenmedi. BMI Grup 1 ve Grup 2 için sırasıyla 26,1±2,3 ve 31,8±3,4 olarak tespit edildi ve anlamlı fark tespit edildi. Preoperatif IIEF skorları, prostat spesifik antijen seviyeleri, prostat hacimleri arasında 2 grup arasında anlamlı fark tespit edilmedi. Ortalama operasyon ve konsol süreleri nonobez grupta anlamlı daha kısa tespit edildi. Peroperatif kanama miktarları Grup 1 ve Grup 2 için sırasıyla 85,6±23,8 ve 134,6±100,5 olarak tespit edildi ve aralarında anlamlı fark tespit edildi. Obez grubunda hastanede kalış süreleri anlamlı daha uzun olarak tespit edildi. Peroperatif ve postoperatif komplikasyon oranları ve ekstraprostatik yayılım, cerrahi sınır pozitifliği, seminal vezikül invazyonu, biyokimyasal rekürrens oranları gibi onkolojik sonuçlarda anlamlı farklılık izlenmedi. Üç, 6 ve 12. aylarda saptanan potens oranlarında ve sonda çekilmesi sonrasında, 3, 6, 9 ve 12. ayların tümünde 2 grup arasında anlamlı fark saptanmadı. Sonuç: RARP, obez hastalarda nonobez hasta grubuna benzer etkinlik ve güvenlikte uygulanabilir. Bununla birlikte, obez hasta grubunda hasta konforu ve fonksiyonel sonuçların daha kötü olduğu tespit edilmiştir.

Anahtar Kelimeler: Obezite; prostat kanseri; robotik yardımlı radikal prostatektomi
ABSTRACT
 Objective: Many studies on the relationship between prostate cancer and obesity have found that obesity and increased adiposity are associated with worse pathological, oncologic and functional outcomes after radical prostatectomy. Given the ever increasing incidence of prostate cancer and obesity rates, physicians are increasingly faced with the difficult surgical management of obese patients with prostate cancer. In this study, we aimed to compare the data of obese and non-obese patients who underwent robot-assisted radical prostatectomy (RARP) for prostate cancer and to investigate the effect of obesity on surgical outcomes. Material and Methods: Data of RARP operation performed for localized prostate cancer between January 2016-January 2018 were reviewed. Demographic, preoperative, peroperative and postoperative data of the patients were recorded. IIEF scores were evaluated at 3, 6 and 12 months postoperatively, as well as continence status after postoperative catheter withdrawal and at 3, 6, 9 and 12 months. Patients were divided into two groups according to body mass index (BMI) scores as non-obese (Group 1: <30 kg/m2) and obese (Group 2: >30 kg/m2) and the results were compared. Results: 73 non-obese and 40 obese patients who underwent RARP were included in the study. The mean age for Group 1 and Group 2 was 60.7±5.9 and 60.3±5.5, respectively, and there was no significant difference between the two groups. BMI for Group 1 and Group 2 were 26.1±2.3 and 31.8±3.4, respectively, and a significant difference was found. Preoperative IIEF scores, prostate specific antigen levels, prostate volumes were not significantly different between the two groups. Mean operation and console times were significantly shorter in non-obese group. Peroperative hemorrhage amounts for Group 1 and Group 2 were 85.6±23.8 and 134.6±100.5, respectively. The length of hospital stay was significantly longer in the obese group. Peroperative and postoperative complication rates and oncologic results such as extraprostatic extension, surgical margin positivity, seminal vesicle invasion, biochemical recurrence rates were not significantly different. No significant difference was found between the 2 groups in the 3, 6, 9, and 12 months after the potency ratios detected at 3,6 and 12 months. Conclusion: RARP can be applied in obese patients with similar efficacy and safety as non-obese patients. However, patient comfort and functional outcomes were found to be worse in the obese group.

Keywords: Obesity; prostate cancer; robotic assisted radical prostatectomy
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