Conversions from partial (PN) to radical nephrectomy (RN) are uncommon and reports on this topic are rare. In this study we present a detailed analysis of conversions from PN to RN in a single institutional contemporary experience and provide an analysis of preoperative risk factors.
Patients who underwent converted (cases) and completed (controls) PN from 2000 to 2015 were matched 1:1 for analysis. Perioperative imaging was reviewed and RENAL nephrometry scores (RENAL-NS) were calculated. Reasons for conversions were abstracted from operative reports. Multivariable conditional logistic regression analyses were used to assess preoperative risk factors for conversion.
A total of 168 cases (6.1% of all PNs) were identified and matched on tumor size, year of surgery, and surgical approach to 168 controls. Conversion rates decreased from 13% in 2000-2003 to 4% in 2012-2015. Oncologic considerations, such as concern for upstaging and positive margins, were the most cited (56%) reasons for conversion. On multivariable analyses, male sex (OR 2.34; p=0.03), Charlson score (OR per 1-unit increase:1.28; p=0.03), posterior and middle (on anteroposterior axis) location (ref: anterior, OR 2.83, p=0.02 and OR 6.38, p<0.001, respectively) and hilar location (ref: peripheral/central, OR 5.61; p<0.001) were associated with increased odds of conversion.
Rates of conversion from PN to RN in our experience were low and decreased over time. Preoperative characteristics such as hilar, posterior, and middle locations were significantly associated with conversions after controlling for tumor size and offer guidance for operative planning and patient counseling.
The Journal of urology. 2022 Jun 24 [Epub ahead of print]
Matvey Tsivian, Daniel D Joyce, Vignesh T Packiam, Christine M Lohse, Stephen A Boorjian, Theodora A Potretzke, George K Chow, Bradley C Leibovich, Vidit Sharma, R Houston Thompson
Department of Urology, Wake Forest Baptist Health Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC., Department of Urology, Mayo Clinic, Rochester MN., Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA., Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN., Department of Radiology, Mayo Clinic, Rochester MN.