Unplanned Conversion From Partial to Radical Nephrectomy: An Analysis of Incidence, Etiology, and Risk Factors

Area of Science:

• Urology
• Surgical Oncology

Background:

• Conversions from partial nephrectomy to radical nephrectomy are infrequent and rarely reported.
• Understanding risk factors for conversion is crucial for surgical planning and patient counseling.

Purpose of the Study:

• To analyze the incidence and preoperative risk factors associated with conversion from partial to radical nephrectomy in a contemporary single-institutional experience.

Main Methods:

• A retrospective analysis matched 168 patients who underwent conversion (cases) with 168 who completed partial nephrectomy (controls) from 2000-2015.
• RENAL nephrometry scores were calculated, and reasons for conversion were abstracted.
• Multivariable conditional logistic regression identified preoperative risk factors for conversion.

Main Results:

• Conversion rates decreased from 13% to 4% between 2000-2003 and 2012-2015.
• Oncologic concerns (upstaging, positive margins) were the most common reasons for conversion (56%).
• Male sex, higher Charlson score, and posterior/middle/hilar tumor locations were significantly associated with increased odds of conversion.

Conclusions:

• Conversion rates from partial to radical nephrectomy are low and have declined over time.
• Preoperative factors including tumor location (hilar, posterior, middle) are significant predictors of conversion.
• These findings provide valuable guidance for operative planning and patient counseling in partial nephrectomy cases.