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

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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

Original languageEnglish
JournalUrology
Early online date25 Dec 2017
DOIs
Publication statusE-pub ahead of print - 25 Dec 2017

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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.

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