Perioperative and early oncological outcomes after robot-assisted radical prostatectomy (RARP) in morbidly obese patients: a propensity score-matched study




  • To evaluate the perioperative and pathological outcomes associated with robot-assisted radical prostatectomy (RARP) in morbidly obese men.

Patients and Methods

  • Between January 2008 and March 2012, 3041 patients underwent RARP at our institution by a single surgeon (V.P.).
  • In all, 44 patients were considered morbidly obese with a body mass index (BMI) of ≥40 kg/m2.
  • A propensity score-matched analysis was conducted using multivariable analysis to identify comparable groups of patients with a BMI of ≥40 and <40 kg/m2.
  • Perioperative, pathological outcomes and complications were compared between the two matched groups.


  • There was no significant difference in operative time. However, the mean estimated blood loss was higher in morbidly obese patients, at a mean (sd) of 113 (41) vs 130 (27) mL (P = 0.049).
  • Anastomosis was more difficult in morbidly obese patients (P = 0.001).
  • There were no significant differences in laterality, ease of nerve sparing, or transfusion rate between the groups.
  • There were no intraoperative complications in either group. Postoperative pathological outcomes were similar between the groups.
  • Differences in positive surgical margins and ease of nerve sparing approached statistical significance (P = 0.097, P = 0.075 respectively). Postoperative complication rates, pain scores, length of stay and indwelling catheter duration were similar in the groups.


  • RARP in morbidly obese patients is technically demanding. However, it can be accomplished with acceptable morbidity and resource use.
  • In the hands of an experienced surgeon, it is a safe procedure and offers beneficial clinical outcomes.