Intraoperative conversion from partial to radical nephrectomy at a single institution from 2003 to 2008
David J Galvin1, Caroline J Savage, Ari Adamy
1Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
The Journal of Urology
|February 22, 2011
Summary
Conversion from partial to radical nephrectomy during kidney surgery is rare. Larger tumors, central location, and lower kidney function increase conversion risk, potentially leading to chronic kidney disease.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Partial nephrectomy is standard for localized kidney tumors.
- Information on conversion to radical nephrectomy is limited.
- Understanding conversion factors is crucial for surgical planning.
Purpose of the Study:
- To assess intraoperative reasons for converting partial nephrectomy to radical nephrectomy.
- To identify predictive factors associated with conversion risk.
Main Methods:
- Retrospective review of 1,029 partial nephrectomy cases (2003-2008).
- Analysis of open and laparoscopic partial nephrectomies with conversion to radical nephrectomy.
- Logistic regression used to identify predictors of conversion.
Main Results:
- Conversion rate was 6% overall (7% open, 1.2% laparoscopic).
- Common reasons included hilar invasion, size discrepancy, and insufficient residual kidney.
- Predictors of conversion: larger tumors, central tumor site, lower preoperative glomerular filtration rate, and symptomatic presentation.
Conclusions:
- Conversion to radical nephrectomy is infrequent but associated with specific factors.
- Predictive factors for conversion include tumor size, location, preoperative renal function, and symptoms.
- Conversion increases the risk of postoperative chronic kidney disease.
