Olga Katzendorn, Frank Schiefelbein, Georg Schoen, Clemens Wiesinger, Jacob Pfuner, Burkhard Ubrig, Simon Gloger, Daniar Osmonov, Ahmed Eraky, Christian Wagner, Abdirahman Ayanle, Mulham Al-Nadar, Claudia Kesch, Boris A Hadaschik, Pouriya Faraj Tabrizi, Mathias Wolters, Markus A Kuczyk, Stefan Siemer, Michael Stoeckle, Philip Zeuschner, Nina N Harke
{"title":"Conversions in robot-assisted partial nephrectomy: a multicentric analysis of 2549 cases.","authors":"Olga Katzendorn, Frank Schiefelbein, Georg Schoen, Clemens Wiesinger, Jacob Pfuner, Burkhard Ubrig, Simon Gloger, Daniar Osmonov, Ahmed Eraky, Christian Wagner, Abdirahman Ayanle, Mulham Al-Nadar, Claudia Kesch, Boris A Hadaschik, Pouriya Faraj Tabrizi, Mathias Wolters, Markus A Kuczyk, Stefan Siemer, Michael Stoeckle, Philip Zeuschner, Nina N Harke","doi":"10.23736/S2724-6051.24.06018-X","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Conversion in partial nephrectomy to radical nephrectomy occurs in 1-5%. This analysis assessed predictors for conversions in robot-assisted partial nephrectomies.</p><p><strong>Methods: </strong>Two thousand five hundred forty-nine patients at eight robotic centers for robot-assisted partial nephrectomy were retrospectively analyzed. Intervention was performed by 25 surgeons with varying expertise. Conversion was defined as change from robot-assisted partial nephrectomy to open partial, open radical or robot-assisted radical nephrectomy. Comparative analyses between converted and non-converted cases and within subgroups as well as multivariate regression analyses for predictors for conversion were performed.</p><p><strong>Results: </strong>Eighty-eight (3.5%) conversions were documented (17% open nephrectomy, 53% open partial nephrectomy, 30% robot-assisted nephrectomy). In case of conversion, patients were significantly older (P<0.001) with a higher Body Mass Index (BMI; P=0.029), larger tumor size (P<0.001), multiple tumors (P<0.001) and higher PADUA scores (P<0.001). Converting surgeons had a significantly lower experience in RAPN (median EXP 64 vs. 29, P<0.001). The main reasons to convert were unfavorable anatomic features (69%). Radical nephrectomy occurred more frequently in tumors with higher PADUA Score (P<0.001). Experienced surgeons in open renal surgery performed more often open partial nephrectomy in case of open conversion (P<0.001). Patients' age, BMI, surgeon's expertise, number of tumors, tumor size and PADUA Score were independent predictors for conversion (P<0.001). Limitations are the retrospective study design and short-term follow-up.</p><p><strong>Conclusions: </strong>Conversions in robot-assisted partial nephrectomy are predominantly determined by patient- and tumor-related factors, but also surgical experience. Intensified surgical training might reduce the risk of conversions with an increased chance for nephron-sparing surgery in converted cases.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva Urology and Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S2724-6051.24.06018-X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Conversion in partial nephrectomy to radical nephrectomy occurs in 1-5%. This analysis assessed predictors for conversions in robot-assisted partial nephrectomies.
Methods: Two thousand five hundred forty-nine patients at eight robotic centers for robot-assisted partial nephrectomy were retrospectively analyzed. Intervention was performed by 25 surgeons with varying expertise. Conversion was defined as change from robot-assisted partial nephrectomy to open partial, open radical or robot-assisted radical nephrectomy. Comparative analyses between converted and non-converted cases and within subgroups as well as multivariate regression analyses for predictors for conversion were performed.
Results: Eighty-eight (3.5%) conversions were documented (17% open nephrectomy, 53% open partial nephrectomy, 30% robot-assisted nephrectomy). In case of conversion, patients were significantly older (P<0.001) with a higher Body Mass Index (BMI; P=0.029), larger tumor size (P<0.001), multiple tumors (P<0.001) and higher PADUA scores (P<0.001). Converting surgeons had a significantly lower experience in RAPN (median EXP 64 vs. 29, P<0.001). The main reasons to convert were unfavorable anatomic features (69%). Radical nephrectomy occurred more frequently in tumors with higher PADUA Score (P<0.001). Experienced surgeons in open renal surgery performed more often open partial nephrectomy in case of open conversion (P<0.001). Patients' age, BMI, surgeon's expertise, number of tumors, tumor size and PADUA Score were independent predictors for conversion (P<0.001). Limitations are the retrospective study design and short-term follow-up.
Conclusions: Conversions in robot-assisted partial nephrectomy are predominantly determined by patient- and tumor-related factors, but also surgical experience. Intensified surgical training might reduce the risk of conversions with an increased chance for nephron-sparing surgery in converted cases.
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