To analyze predictors of open conversion during Minimally Invasive Partial Nephrectomy (MIPN) for cT1 renal masses.
The National Cancer Database (NCDB) was investigated for kidney cancer patients who underwent partial nephrectomy (PN) between 2010 and 2015. Patients who underwent MIPN were stratified into converted and non-converted groups. Sociodemographics, facility characteristics and surgical outcomes were compared between the two groups, and multivariate logistic regression model was fitted to identify independent predictors of open conversion.
In total, 54,246 patients underwent PN for kidney cancer during the 6-year period. Of those, 18,994 (35%) were open partial nephrectomies (OPN) and 35,252 (64%) were MIPN. Overall, 1,010 (2.87%) of MIPNs were converted to OPN. There was an increasing utilization of MIPN from 50.35% in 2010 to 74.73% in 2015. Patients who had open conversion had more 30-day readmissions (5.95% vs. 3.31%, p<0.01). On multivariate analysis; high facility volume (>30 MIPNs/year), year of surgery (2015 vs. 2010) and robotic approach predicted a lower likelihood of conversion (Odds Ratio [OR] 0.52, CI 0.44 - 0.62; OR 0.59, CI 0.47 - 0.73; and OR 0.31, CI 0.27 - 0.35; respectively, p<0.001 for all). Conversely, Medicaid (vs. private insurance; OR 1.75, CI 1.39 -2.19, p <0.001) and male sex (OR 1.26, CI 1.11 - 1.44, p<0.001) were independent predictors of conversion.
Open conversion in MIPN was performed in 2.87% of cases. There was an increasing utilization of MIPN associated with decreased conversion rates. Higher volume hospitals and progressing year of surgery were associated with less likelihood of conversion.
Journal of endourology. 2020 May 21 [Epub ahead of print]
Geraldine Klein, Hanzhang Wang, Ahmed Elshabrawy, Mouhamed Nashawi, Eric Gourley, Michael Liss, Dharam Kaushik, Shenghui Wu, Ronald Rodriguez, Ahmed M Mansour
UTHSC at San Antonio, 14742, Urology, San Antonio, Texas, United States; ., University of Texas Health Science Center at San Antonio, 14742, Department of Urology, San Antonio, Texas, United States; ., UTHSC at San Antonio, 14742, Urology, 7703 Floyd Curl Drive, San Antonio, San Antonio, Texas, United States, 78229; ., UTHSC at San Antonio, 14742, Urology, 7703 Floyd Curl Dr., San Antonio, Texas, United States, 78229; ., UTHSC at San Antonio, 14742, Urology, San Antonio, Texas, United States; ., University of California San Diego Health System, Urology, San Diego, California, United States; ., University of Texas Health Science Center at San Antonio, 14742, Department of Urology, San Antonio, Texas, United States; ., UTHSC at San Antonio, 14742, Urology, San Antonio, Texas, United States; ., University of Texas Health Science Center at San Antonio, 14742, Department of Urology, San Antonio, Texas, United States; ., Urlogy and Nephrology Center, Urology, 72 Elgomhoreya street, Mansoura, Mansoura, Egypt, 35516.