Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study

Sohrab Arora; Brian Chun; Rajesh K. Ahlawat; Ronney Abaza; James Adshead; James R. Porter; Benjamin Challacombe; Prokar Dasgupta; Giorgio Gandaglia; Daniel A. Moon; T.B. Yuvaraja; Umberto Capitanio; Alessandro Larcher; Francesco Porpiglia; Alexander Mottrie; Mahendra Bhandari; Craig Rogers

doi:10.1016/j.urology.2017.11.046

Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study

Sohrab Arora, Brian Chun, Rajesh K. Ahlawat, Ronney Abaza, James Adshead, James R. Porter, Benjamin Challacombe, Prokar Dasgupta, Giorgio Gandaglia, Daniel A. Moon, T.B. Yuvaraja, Umberto Capitanio, Alessandro Larcher, Francesco Porpiglia, Alexander Mottrie, Mahendra Bhandari, Craig Rogers

Policy Institute at King's

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Abstract

Objectives To assess the incidence, and factors affecting conversion from robot-assisted partial nephrectomy (RAPN) to radical nephrectomy. Methods Between November 2014 and February 2017, 501 patients underwent attempted RAPN by 22 surgeons at 14 centers in nine countries within the Vattikuti Collaborative Quality Initiative database. Patients were permanently logged for RAPN prior to surgery and were analysed on an intention-to-treat basis. Multivariable logistic regression with backward stepwise selection of variables was done to assess the factors associated with conversion to radical nephrectomy. Results Overall conversion rate was 25/501 (4.99%). Patients converted to radical nephrectomy were older (median age [interquartile range] 66.0 [61.0-74.0] vs 59.0 [50.0-68.0], P=0.012), had higher body mass index (median 32.8 [24.9-40.9] vs. 27.8 [24.6-31.5] Kg/m2, P = 0.031), higher age-adjusted Charlson comorbidity score (median 6.0 [4.0-7.0] vs. 4.0 [3.0-5.0], P < 0.001), higher American Society of Anesthesiologists score (Score ≥3; 13/25 (52.0%) vs 130/476 (27.3%), P = 0.021), Preoperative estimated glomerular filtration rate (P=0.141), clinical tumor stage (P=0.145), tumor location (P=0.140), multifocality (P=0.483) and RENAL nephrometry score (P=0.125) were not significantly different between the groups. On multivariable analysis, independent predictors for conversion were BMI (odds ratio [95% CI]; 1.070 [1.018-1.124]; P = 0.007), and Charlson score (odds ratio [95% CI]; 1.459 [1.179-1.806]; P = 0.001). Conclusions RAPN was associated with a low rate of conversion. Independent predictors of conversion were body mass index and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.

Original language	English
Journal	Urology
Early online date	25 Dec 2017
DOIs	https://doi.org/10.1016/j.urology.2017.11.046
Publication status	E-pub ahead of print - 25 Dec 2017

Keywords

Nephrectomy
kidney neoplasms-surgery
kidney neoplasms-renal cell cardinoma
robotic surgical procedures

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.urology.2017.11.046

Conversion of Robot Assisted_ARORA_Publishedonline25December2017_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 723 KBLicence: CC BY-NC-ND

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Arora, S., Chun, B., Ahlawat, R. K., Abaza, R., Adshead, J., Porter, J. R., Challacombe, B., Dasgupta, P., Gandaglia, G., Moon, D. A., Yuvaraja, T. B., Capitanio, U., Larcher, A., Porpiglia, F., Mottrie, A., Bhandari, M., & Rogers, C. (2017). Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study. Urology. Advance online publication. https://doi.org/10.1016/j.urology.2017.11.046

@article{6722806253d8466493b4eb0b378d84e2,

title = "Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study",

abstract = "Objectives To assess the incidence, and factors affecting conversion from robot-assisted partial nephrectomy (RAPN) to radical nephrectomy. Methods Between November 2014 and February 2017, 501 patients underwent attempted RAPN by 22 surgeons at 14 centers in nine countries within the Vattikuti Collaborative Quality Initiative database. Patients were permanently logged for RAPN prior to surgery and were analysed on an intention-to-treat basis. Multivariable logistic regression with backward stepwise selection of variables was done to assess the factors associated with conversion to radical nephrectomy. Results Overall conversion rate was 25/501 (4.99%). Patients converted to radical nephrectomy were older (median age [interquartile range] 66.0 [61.0-74.0] vs 59.0 [50.0-68.0], P=0.012), had higher body mass index (median 32.8 [24.9-40.9] vs. 27.8 [24.6-31.5] Kg/m2, P = 0.031), higher age-adjusted Charlson comorbidity score (median 6.0 [4.0-7.0] vs. 4.0 [3.0-5.0], P < 0.001), higher American Society of Anesthesiologists score (Score ≥3; 13/25 (52.0%) vs 130/476 (27.3%), P = 0.021), Preoperative estimated glomerular filtration rate (P=0.141), clinical tumor stage (P=0.145), tumor location (P=0.140), multifocality (P=0.483) and RENAL nephrometry score (P=0.125) were not significantly different between the groups. On multivariable analysis, independent predictors for conversion were BMI (odds ratio [95% CI]; 1.070 [1.018-1.124]; P = 0.007), and Charlson score (odds ratio [95% CI]; 1.459 [1.179-1.806]; P = 0.001). Conclusions RAPN was associated with a low rate of conversion. Independent predictors of conversion were body mass index and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.",

keywords = "Nephrectomy, kidney neoplasms-surgery, kidney neoplasms-renal cell cardinoma, robotic surgical procedures",

author = "Sohrab Arora and Brian Chun and Ahlawat, {Rajesh K.} and Ronney Abaza and James Adshead and Porter, {James R.} and Benjamin Challacombe and Prokar Dasgupta and Giorgio Gandaglia and Moon, {Daniel A.} and T.B. Yuvaraja and Umberto Capitanio and Alessandro Larcher and Francesco Porpiglia and Alexander Mottrie and Mahendra Bhandari and Craig Rogers",

year = "2017",

month = dec,

day = "25",

doi = "10.1016/j.urology.2017.11.046",

language = "English",

journal = "Urology",

issn = "0090-4295",

publisher = "Elsevier Inc.",

}

Arora, S, Chun, B, Ahlawat, RK, Abaza, R, Adshead, J, Porter, JR , Challacombe, B , Dasgupta, P, Gandaglia, G, Moon, DA, Yuvaraja, TB, Capitanio, U, Larcher, A, Porpiglia, F, Mottrie, A, Bhandari, M & Rogers, C 2017, 'Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study', Urology. https://doi.org/10.1016/j.urology.2017.11.046

TY - JOUR

T1 - Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study

AU - Arora, Sohrab

AU - Chun, Brian

AU - Ahlawat, Rajesh K.

AU - Abaza, Ronney

AU - Adshead, James

AU - Porter, James R.

AU - Challacombe, Benjamin

AU - Dasgupta, Prokar

AU - Gandaglia, Giorgio

AU - Moon, Daniel A.

AU - Yuvaraja, T.B.

AU - Capitanio, Umberto

AU - Larcher, Alessandro

AU - Porpiglia, Francesco

AU - Mottrie, Alexander

AU - Bhandari, Mahendra

AU - Rogers, Craig

PY - 2017/12/25

Y1 - 2017/12/25

N2 - Objectives To assess the incidence, and factors affecting conversion from robot-assisted partial nephrectomy (RAPN) to radical nephrectomy. Methods Between November 2014 and February 2017, 501 patients underwent attempted RAPN by 22 surgeons at 14 centers in nine countries within the Vattikuti Collaborative Quality Initiative database. Patients were permanently logged for RAPN prior to surgery and were analysed on an intention-to-treat basis. Multivariable logistic regression with backward stepwise selection of variables was done to assess the factors associated with conversion to radical nephrectomy. Results Overall conversion rate was 25/501 (4.99%). Patients converted to radical nephrectomy were older (median age [interquartile range] 66.0 [61.0-74.0] vs 59.0 [50.0-68.0], P=0.012), had higher body mass index (median 32.8 [24.9-40.9] vs. 27.8 [24.6-31.5] Kg/m2, P = 0.031), higher age-adjusted Charlson comorbidity score (median 6.0 [4.0-7.0] vs. 4.0 [3.0-5.0], P < 0.001), higher American Society of Anesthesiologists score (Score ≥3; 13/25 (52.0%) vs 130/476 (27.3%), P = 0.021), Preoperative estimated glomerular filtration rate (P=0.141), clinical tumor stage (P=0.145), tumor location (P=0.140), multifocality (P=0.483) and RENAL nephrometry score (P=0.125) were not significantly different between the groups. On multivariable analysis, independent predictors for conversion were BMI (odds ratio [95% CI]; 1.070 [1.018-1.124]; P = 0.007), and Charlson score (odds ratio [95% CI]; 1.459 [1.179-1.806]; P = 0.001). Conclusions RAPN was associated with a low rate of conversion. Independent predictors of conversion were body mass index and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.

AB - Objectives To assess the incidence, and factors affecting conversion from robot-assisted partial nephrectomy (RAPN) to radical nephrectomy. Methods Between November 2014 and February 2017, 501 patients underwent attempted RAPN by 22 surgeons at 14 centers in nine countries within the Vattikuti Collaborative Quality Initiative database. Patients were permanently logged for RAPN prior to surgery and were analysed on an intention-to-treat basis. Multivariable logistic regression with backward stepwise selection of variables was done to assess the factors associated with conversion to radical nephrectomy. Results Overall conversion rate was 25/501 (4.99%). Patients converted to radical nephrectomy were older (median age [interquartile range] 66.0 [61.0-74.0] vs 59.0 [50.0-68.0], P=0.012), had higher body mass index (median 32.8 [24.9-40.9] vs. 27.8 [24.6-31.5] Kg/m2, P = 0.031), higher age-adjusted Charlson comorbidity score (median 6.0 [4.0-7.0] vs. 4.0 [3.0-5.0], P < 0.001), higher American Society of Anesthesiologists score (Score ≥3; 13/25 (52.0%) vs 130/476 (27.3%), P = 0.021), Preoperative estimated glomerular filtration rate (P=0.141), clinical tumor stage (P=0.145), tumor location (P=0.140), multifocality (P=0.483) and RENAL nephrometry score (P=0.125) were not significantly different between the groups. On multivariable analysis, independent predictors for conversion were BMI (odds ratio [95% CI]; 1.070 [1.018-1.124]; P = 0.007), and Charlson score (odds ratio [95% CI]; 1.459 [1.179-1.806]; P = 0.001). Conclusions RAPN was associated with a low rate of conversion. Independent predictors of conversion were body mass index and Charlson score. Tumor factors such as clinical stage, location, multifocality, or RENAL score were not associated with increased risk of conversion.

KW - Nephrectomy

KW - kidney neoplasms-surgery

KW - kidney neoplasms-renal cell cardinoma

KW - robotic surgical procedures

U2 - 10.1016/j.urology.2017.11.046

DO - 10.1016/j.urology.2017.11.046

M3 - Article

SN - 0090-4295

JO - Urology

JF - Urology

ER -

Conversion of Robot Assisted Partial Nephrectomy to Radical Nephrectomy; a Prospective Multi-Institutional Study

Abstract

Keywords

UN SDGs

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