A Single-Institution Comparison Between Radical Perineal and Radical Retropubic Prostatectomy on Perioperative and Pathological Outcomes for Obese Men: An Analysis of the Duke Prostate Center Database

Objectives: To examine the association between body mass index (BMI) and operative time, estimated blood loss (EBL), and adverse pathologic features in patients undergoing either radical perineal prostatectomy (RPP) or radical retropubic prostatectomy (RRP). Methods: We performed a retrospective analysis of 1006 patients treated with RPP or RRP at our institution from 1988 to 2005. Operative times and EBL were compared among BMI groups for both RPP and RRP. The odds ratio of positive surgical margins was estimated for the BMI categories using logistic regression after adjusting for preoperative and pathologic characteristics. Results: Increased BMI was significantly associated with increased operative time and EBL for men treated with either RPP or RRP (all P ≤0.03), though the associations were weak (all Spearman r ≤0.19). After adjusting for multiple clinical preoperative characteristics, higher BMI was associated with positive surgical margins among all patients (P trend <0.001). The association between obesity and surgical margins remained after adjusting for pathologic characteristics (P trend = 0.001) with similar patterns among RRP (P trend = 0.03) and RPP (P trend = 0.01) patients. Conclusions: For mildly obese men, both RPP and RRP are associated with a similarly increased risk of higher EBL, longer operative time, and positive surgical margins. These data do not provide evidence to suggest that RPP should be preferred over RRP for mildly obese men. Further study is needed among men with a very high BMI.