Impact of body mass index on robot-assisted radical cystectomy

Background and Objectives: Obesity is a major comorbidity in the Western world and influences outcomes of patient care. A minimally invasive approach towards radical cystectomy has been increasing in popularity. We sought to determine the influence of body mass index (BMI) on robot-assisted radical cystectomy. Methods: Fifty-one consecutive patients underwent robot-assisted radical cystectomy for bladder cancer from October 2005 to April 2007 and were categorized into 3 groups based on their weight: normal (BMI <25), over-weight (BMI=25 to 29) and obese (BMI = 30 to 39.9). Effect of BMI on intraoperative, pathologic, and postoperative outcomes was assessed by retrospective review of the robot-assisted radical cystectomy database. Results: Mean BMI was 28.0, and 71% of the patients were overweight or obese. BMI did not correlate with age, sex, or American Society of Anesthesiologists (ASA) score. Overweight and obese patients had similar operative times and estimated blood loss compared with patients with normal BMI. Overweight and obese patients with bulky disease (pT3-4) had significantly higher rates of positive surgical margins (P=0.05). Complication rates were similar. Conclusion: Robotic-assisted radical cystectomy can be considered for patients of all body mass indices. Wider excision should be performed in patients with higher BMI.