Intraoperative Conversion From Partial to Radical Nephrectomy: Incidence, Predictive Factors, and Outcomes

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Partial nephrectomy (PN) is the standard for small renal masses.
• Conversion to radical nephrectomy (RN) may be necessary due to unforeseen intraoperative findings.

Purpose of the Study:

• To identify preoperative and intraoperative predictors of conversion from planned PN to RN for renal cell carcinoma (RCC).

Main Methods:

• Retrospective review of a single-center PN database (1990-2016).
• Comparison of patients converted to RN versus successful PN.
• Univariate and multivariate logistic regression analyses to determine predictors of conversion.

Main Results:

• 5% of 1857 planned PN cases were converted to RN.
• Predictors of conversion included larger tumor size, higher RENAL nephrometry score, hilar/renal sinus invasion, laparoscopic approach, intraoperative bleeding, positive surgical margin, and advanced pathologic tumor stage (T3/T4).

Conclusions:

• Conversion from planned PN to RN is infrequent.
• Tumor complexity, location, advanced stage, laparoscopic approach, bleeding, and positive margins are associated with conversion.