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Quick Summary of Key Findings (at a glance)

Outcome                               Obese Patients                              Non-Obese Patients                  Difference

‍Operation                         TimeLonger (by 18 minutes)    Shorter ⬆                                 More time needed

Hospital Stay                    0.18 days longer                       Shorter stay⬆︎                          Slightly longer

Blood Loss                        More bleeding                          Less bleeding⬆︎                       Technically more difficult

Complication Rate            1.6× higher                                Lower⬆︎                                    Significantly higher

Major Complications        30% higher                                Lower ⬆︎                                   Increased surgical risk

Incontinence at 1 Year      17% more likely                         Less incontinence⬆︎                 More pad use

Erectile Dysfunction          8% more likely                          Better recovery⬆︎                     Slight reduction in potency

Positive Surgical Margins  20% more likely                        Lower PSM⬆︎                            Higher risk of recurrence

What is robot-assisted radical prostatectomy?

Robot-assisted radical prostatectomy (RARP) is a high-precision, minimally invasive procedure to remove the prostate gland when treating localised prostate cancer.

It uses robotic arms controlled by the surgeon from a console, offering:

• Smaller cuts
• Less bleeding
• Faster recovery
• Better chance of preserving erections and continence

Why Is Obesity a Concern in Prostate Cancer Surgery?

Obesity is defined as a BMI of 30 or above. It affects about 25% of UK men, according to theNHS.

In prostate cancer, obesity can:

• Make surgery more complex
• Delay healing
• Increase the risk of complications
• Reduce cancer control

This review looked at how obesity impacts outcomes specifically after robotic prostatectomy.

How Does Obesity Affect the Surgery and Recovery?

• Operating Time: On average, 18 minutes longer in obese men.
• Hospital Stay: Around 4 hours longer.
• Blood Loss: Increased by about 50 ml.

These differences are linked to:

• More abdominal fat around the prostate
• Reduced visibility and space during surgery
• Higher blood supply to fatty tissues

Are There More Complications in Obese Patients?

Yes. The review showed a clear rise in complication rates:

• Overall complications were 60% higher
• Major complications were 30% higher
• Minor complications (e.g. infections) were also more common

Does Obesity Affect Continence and Erections?

Continence:

• Obese men were 17% more likely to be incontinent at 1 year.
• Reasons include:
  • Weaker pelvic floor support
  • Difficulties sparing nerves and muscles during surgery

Erectile Function:

• 8% more likely to experience erectile dysfunction
• More fat around the neurovascular bundles makes it harder to preserve these critical structures

Does Obesity Impact Cancer Outcomes?

Positive Surgical Margins (PSM):

• Risk was 20% higher in obese patients.
• This means some cancer cells were left at the edge of the prostate, increasing the risk of recurrence.

Will Losing Weight Before Surgery Help?

Yes — the study authors suggest that weight loss before surgery can:

• Improve visibility and ease of surgery
• Reduce operation time and blood loss
• Lower risk of complications
• Improve recovery of continence and potency
• Possibly reduce the chance of cancer recurrence

Even losing 5–10% of body weight can lead to noticeable benefits.

Robotic Prostate Surgery in the UK: What Patients Should Know

If you are obese and have been diagnosed with prostate cancer, you can still undergo robotic prostate surgery in the UK.

In the private sector:

• Many centres across the UK offer robotic prostatectomy using the da Vinci system.
• Prehabilitationg diet advice, weight loss support, and physical fitness — may be available to help improve your outcome.

If your BMI is over 30, your urologist may still recommend surgery but with extra precautions to reduce risks and support your recovery.

Frequently Asked Questions (FAQs)

❓ Is robotic prostate surgery riskier if I’m overweight?

Yes, slightly. Obese patients have a higher risk of complications, longer operations, and worse continence and potency outcomes. However, robotic surgery is still often the safest option for cancer control.

❓ Should I lose weight before prostate surgery?

Yes. Weight loss can:

• Make the operation easier
• Reduce your chance of complications
• Help with quicker return to continence and erections

Even losing 5–10% of body weight can help.

❓ Can I still have robotic prostate surgery if my BMI is over 35?

In most cases, yes. The decision depends on your overall health, cancer stage, and surgical risk. Surgeons may recommend extra support before and after surgery.

❓ Is open surgery safer for obese men?

Not usually. Robotic surgery is still preferred in obese patients because it allows better vision, smaller incisions, and less trauma — even in more challenging anatomy.

Can Obese Men Still Benefit from Robotic Prostate Cancer Surgery?

Absolutely. Robotic surgery remains a safe and effective treatment for prostate cancer in obese men. However, the risks are slightly higher, and personalised counselling is essential.

Weight loss, even before surgery, can make a meaningful difference to outcomes, both in terms of safety and cancer control.

For men with obesity, a robotic approach in expert hands—paired with thoughtful preparation—remains a valuable option in the fight against prostate cancer.

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