The SPARE score reliably predicts the conversion from open partial to radical nephrectomy.

Area of Science:

• Urology
• Surgical Oncology

Background:

• Partial nephrectomy (PN) is preferred for small renal masses, but conversion to radical nephrectomy (RN) can occur.
• Nephrometry scores aim to standardize pre-operative assessment and predict surgical outcomes.
• Predicting intraoperative conversion is crucial for patient counseling and surgical strategy.

Purpose of the Study:

• To evaluate the predictive power of four nephrometry scores (R.E.N.A.L., PADUA, SPARE, DAP) for intraoperative conversion from PN to RN.
• To identify optimal threshold values for these scores in predicting conversion.

Main Methods:

• Retrospective analysis of 149 patients undergoing open PN between 2012 and 2017.
• Exclusion of robotic and laparoscopic cases.
• Assessment of R.E.N.A.L., PADUA, SPARE, and DAP scores for predicting conversion to RN using univariate and multivariate analyses.

Main Results:

• The overall conversion rate was 10.7%.
• The SPARE score demonstrated the highest predictive accuracy (AUC=0.807).
• Optimal cut-off values were identified for each score; a high SPARE score (≥5.5) significantly increased the odds of conversion (OR 12.561).

Conclusions:

• The SPARE score is a valuable tool for predicting intraoperative conversion to radical nephrectomy in patients undergoing open partial nephrectomy.
• High SPARE scores are significantly associated with increased likelihood of conversion, informing surgical decision-making.