Preparing for the Worst: Management and Predictive Factors of Open Conversion During Minimally Invasive Renal Tumor...

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Open conversion (OC) data in minimally invasive surgery (MIS) for renal tumors lack detailed reasons and management strategies.
• Understanding OC is crucial for improving patient outcomes in renal tumor surgery.

Purpose of the Study:

• To determine the incidence, reasons, and perioperative outcomes of OC in patients undergoing MIS for renal tumors.
• To identify factors associated with OC during these procedures.

Main Methods:

• Analysis of a prospective database (UroCCR project, NCT03293563) of 8566 patients undergoing laparoscopic or robot-assisted nephrectomy (partial or radical) between 2008 and 2022.
• Contacting centers to classify OC as 'emergency' or 'elective' and using a 2:1 paired cohort to identify predictive factors.

Main Results:

• The overall incidence of OC was 1.9% (2.9% for radical, 1.4% for partial nephrectomy).
• Most OCs were elective (82.2%), primarily due to anatomical difficulties (42.9%).
• Increased body mass index (BMI) and clinical T stage (cT stage) were independent predictors of OC.

Conclusions:

• Open conversion is an uncommon event in MIS for renal tumors, with a low rate of emergency conversions.
• Perioperative outcomes can be affected by OC, highlighting the importance of identifying predictive factors.
• Elevated BMI and advanced cT stage are significant risk factors for OC, informing surgical planning and patient selection.