The Impact of Obesity in Patients Undergoing Robotic Partial Nephrectomy.

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Journal of endourology / Endourological Society


INTRODUCTION/BACKGROUND: As the prevalence of obesity increases worldwide, an increasing proportion of surgical candidates have an elevated BMI, with associated metabolic syndrome. Yet there exists limited evidence regarding the effect of elevated BMI on surgical outcomes in robotic surgeries. We examined whether obese patients had worse perioperative outcomes and postoperative renal function following robotic partial nephrectomies (RPNs).

METHODS/MATERIALS: We performed a multi-institutional analysis of 1,770 patients who underwent RPNs between 2008 and 2015, allowing time for the dataset to mature. Associations between BMI, as a continuous and categorical variable, and perioperative outcomes, acute kidney injury (AKI, >25% reduction in eGFR) at discharge, and change in eGFR per month were analyzed. AKI and eGFR were evaluated using multivariable logistic and linear regression models adjusted for confounders including age, Charlson comorbidity index, tumor size, and the identity of the surgeon.

RESULTS: 45.2% (n=529) of patients were found to be obese, with a greater prevalence of hypertension and diabetes in overweight and obese patients. Obese patients were more likely to have malignant tumors (>77% vs. 68%, p.05). On multivariable analysis, obesity (OR=1.81; p=0.031), male sex (OR=1.54; p=0.028), and larger tumor size (OR=1.23; p

CONCLUSIONS: Obesity was associated with equivalent perioperative outcomes and long term renal function. Further research is warranted into how obesity and metabolic syndrome may foster a more aggressive tumor environment. RPN appears to be an equally safe operative option for patients regardless of obesity status.

Clinical Institute

Kidney & Diabetes