Obesity and positive surgical margins by anatomic location after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database

Authors

  • The SEARCH Database Study Group:,

    1. Urology Section, Veterans Affairs Medical Center,
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  • Jayakrishnan Jayachandran,

    1. Urology Section, Veterans Affairs Medical Center,
    2. Division of Urologic Surgery, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine,
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  • William J. Aronson,

    1. Urology Section, Veterans Affairs Greater Los Angeles Healthcare System,
    2. Department of Urology, UCLA School of Medicine, Los Angeles,
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  • Martha K. Terris,

    1. Urology Section, Veterans Affairs Medical Center,
    2. Section of Urology, Medical College of Georgia, Augusta, GA,
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  • Joseph C. Presti Jr,

    1. Department of Urology, Stanford University School of Medicine,
    2. Urology Section, Veterans Affairs Medical Center, Palo Alto,
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  • Christopher L. Amling,

    1. Department of Urology, University of Alabama Birmingham, Birmingham, AL, and
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  • Christopher J. Kane,

    1. Division of Urology, University of California, San Diego School of Medicine, San Diego, CA, USA
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  • Stephen J. Freedland

    Corresponding author
    1. Urology Section, Veterans Affairs Medical Center,
    2. Division of Urologic Surgery, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine,
    3. Department of Pathology, Duke University School of Medicine, Durham, NC,
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Stephen J. Freedland, Division of Urology, Box 2626 DUMC, Duke University School of Medicine, Durham, NC 27710, USA.e-mail: steve.freedland@duke.edu

Abstract

OBJECTIVES

To determine if there is predilection for any specific anatomical location of positive surgical margins (PSMs) after radical prostatectomy (RP) for prostate cancer in obese men, as previous studies found that obesity was associated with an increased risk of PSMs.

PATIENTS AND METHODS

We analysed retrospectively 1434 men treated with RP between 1989 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The association between increased body mass index (BMI) and overall and site-specific PSMs was assessed using multivariate logistic regression.

RESULTS

After adjusting for several preoperative clinical and pathological characteristics, a higher BMI was associated with an increased risk of PSMs both overall and at all specific anatomical locations (all P ≤ 0.007). For mildly obese men, this risk was very similar across all anatomical sites (44–78% increased risk relative to men of normal weight). When BMI was coded as a continuous variable, the odds ratio for the risk of overall PSMs or at any specific locations was nearly identical at 1.05–1.06. Among men with a BMI of ≥35 kg/m2, there was more variation, with the highest excess risk of PSMs at the bladder neck and apex.

CONCLUSIONS

Obesity was associated with an increased risk of overall PSMs and at all anatomical locations. Although the excess risk of PSMs was similar across all anatomical locations, there was a suggestion of a higher risk of apical margins among the most obese men, which if validated, further supports the importance of the apical dissection in all men and suggests added difficulty in obese patients.

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