Effect of Diabetes Mellitus on Patients Receiving Robotic-Assisted Laparoscopic Radical Prostatectomy for Prostate Cancer

CP Hou, PY Pan, YH Chang, YC Hsu, YH Lin, CL Chen, PS Yang, PL Chang, KH Tsui

Background: The purpose of this study was to evaluate whether diabetes mellitus (DM) affects outcomes in patients receiving robotic-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer.

Patients and Methods: We compared the early clinical results of diabetic and nondiabetic patients in terms of preoperative (pre-OP) variables and surgical outcomes. Patient records were obtained from a review of the database for prostate cancer patients receiving RARP at Chang-Gung Memorial Hospital, Taiwan, between July 2012 and December 2014. The patients underwent a comprehensive physical examination and medical history review and were classified into two groups: diabetic (DM cohort) and nondiabetic (non-DM cohort). The pre-OP variables and intraoperative and postoperative (post-OP) data of the two cohorts were compared. In addition, biochemical recurrence (BCR)-free survival and urinary continence recovery in the cohorts were compared.

Results: In total, 363 patients (84 DM; 279 non-DM) were enrolled. Compared with the non-DM cohort, patients in the DM cohort were older (68 vs. 65 years, p = 0.002) and had a higher BMI (26.2 vs. 24.8 kg, p = 0.009); the DM cohort also had a higher proportion of clinical T3a (35.7% vs. 26.5%, p < 0.001) and Gleason score 8–10 (26.2% vs. 14.3%, p = 0.019). Intraoperatively, the two cohorts were similar in terms of operative time, blood loss, hospital stay, transfusion rates, and surgical complication rates. However, the final pathology stage of the DM cohort seemed to be more advanced than that of the non-DM cohort. The BCR-free survival was similar in both cohorts, but the speed of recovery from urinary incontinence differed. The continence rates in the DM cohort at post-OP 3 months, 6 months, and 12 months were 30.9%, 45.0%, and 62.8%, respectively, whereas those in the non-DM cohort were 43.0%, 66.5%, and 94.9%, respectively (p < 0.001). Through univariate and multivariate logistic regression analysis, we discovered that DM was an independent factor that affected urinary incontinence at post-OP 6 months.

Conclusion: DM patients could achieve a favorable radical prostatectomy outcome with the utility of da Vinci robotic arms. However, diabetes is an unfavorable factor affecting recovery from post-OP urinary incontinence.