Purpose: We assessed the feasibility of radical perineal prostatectomy (RPP) in morbidly obese patients with clinically organ confined prostate cancer.
Materials and methods: Of 1,265 consecutive patients who underwent RPP at our institution from 1992 to 2003 we identified 18 with a body mass index (BMI) of 40 kg/m or greater. Demographic and clinical patient characteristics were obtained from the medical records, which were further reviewed to identify the perioperative incidence of surgical and anesthesia related complications.
Results: Median BMI was 41.7 kg/m (range 40.2 to 62.6). Five patients had a BMI of 45.0 kg/m or greater. No intraoperative or anesthesia related complication occurred. Mean operative time +/- SD was 188 +/- 32 minutes and estimated blood loss was 573 +/- 285 ml. None of the 18 patients received blood transfusions. During the immediate postoperative period 4 complications occurred in the form of lower extremity neuropraxia in 2 patients, local skin bleeding in 1 and early sepsis in 1 requiring rehospitalization for intravenous antibiotics. Mean operative time and estimated blood loss were significantly lower when surgery was performed by a highly experienced surgeon compared with experienced surgeons (174 +/- 21 vs 235 +/- 10 minutes and 485 +/- 258 vs 838 +/- 197 ml, p = 0.001 and 0.027, respectively).
Conclusions: RPP in morbidly obese patients is feasible and it is associated with acceptable perioperative morbidity. The perineal approach should be considered in morbidly obese patients seeking surgical treatment for clinically localized prostate cancer.