Abstract
We evaluated the association of body mass index (BMI) with perioperative outcomes in patients who underwent laparoscopic or open radical nephroureterectomy. This retrospective single-center study included 113 patients who had been diagnosed with upper urinary tract cancer from January 1998 to June 2013 and were treated with laparoscopic nephroureterectomy (Lap group, n=60) or open nephroureterectomy (Open group, n=53). Laparoscopic nephroureterectomy was performed via a retroperitoneal approach following an open partial cystectomy. The two surgical groups were stratified into a normal-BMI group (<25) and a high-BMI group (BMI≥25). The high-BMI group included 27 patients: 13 in the Lap group and 14 in the Open group. Estimated blood loss (EBL) in the Lap group was much lower than that in the Open group irrespective of BMI (p<0.01). Operative time was significantly prolonged in normal-BMI patients in the Lap group compared to those in the Open group (p=0.03), but there was no difference in operative time between the Open and Lap groups among the high-BMI patients. Multivariate logistic regression analysis of the data for all the cohorts revealed that the open procedure was a significant risk factor for high EBL (p<0.0001, hazard ratio 8.02). Normal BMI was an independent predictor for low EBL (p=0.01, hazard ratio 0.25). There was no significant risk factor for operative time in multivariate analysis. There were no differences in blood transfusion rates or adverse event rates between the two surgical groups. Laparoscopic radical nephroureterectomy via a retroperitoneal approach can be safely performed with significantly reduced EBL even in obese patients with upper urinary tract cancer.
Highlights
The prevalence of obesity has been dramatically increasing worldwide for decades
We evaluated the association of body mass index (BMI) with perioperative outcomes in patients who underwent laparoscopic or open radical nephroureterectomy
Laparoscopic radical nephroureterectomy via a retroperitoneal approach can be safely performed with significantly reduced Estimated blood loss (EBL) even in obese patients with upper urinary tract cancer
Summary
The prevalence of obesity has been dramatically increasing worldwide for decades. In Japanese aged more than 20 years, the prevalences of preobesity (BMI=25-29.9) and obesity (BMI>30) have been reported to be approximately 20% and 3%, respectively (Yoshiike et al, 2002). The proportion of obese people is lower in Japan than in Europe and the Americas, the prevalence of pre-obesity and obesity in the Japanese population has been reported to be linearly increasing in recent years. Obesity is associated with an increased risk of postoperative complications and carcinogenesis (Mendoza et al, 1996; Rapp et al, 2005; Kruk, 2014; Oh et al, 2014; Ozbek et al, 2014). Epidemiological reports have shown that obesity results in increased incidence of and mortality from a variety of cancers (Reeves et al, 2007)
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