Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Urol. 2011 Apr;185(4):1204-9. doi: 10.1016/j.juro.2010.11.077. Epub 2011 Feb 22.
Little information exists on conversion from partial to radical nephrectomy. We assessed the intraoperative reasons and predictive factors for conversion in a contemporary series of patients undergoing partial nephrectomy.
We identified all patients at our institution who underwent open or laparoscopic partial nephrectomy with conversion to radical nephrectomy between 2003 and 2008. Renal function was assessed by the glomerular filtration rate using the modification of diet in renal disease equation. We used logistic regression analysis to determine whether tumor site, tumor size, body mass index, American Society of Anesthesiologists score, age or gender was associated with the conversion risk.
The rate of conversion to radical nephrectomy was 6% (61 of 1,029 patients). In the open partial nephrectomy group 59 of 865 cases (7%, 95% CI 5-9) and in the laparoscopic partial nephrectomy group 2 of 164 (1.2%, 95% CI 0.01-4) were converted. The most common reasons for conversion were invasion of hilar structures, size discrepancy and insufficient residual kidney. Patients with conversion were more likely to have larger tumors (per 1 cm increase OR 1.41, 95% CI 1.24-1.59), a central site (central vs peripheral OR 7.74, 95% CI 3.98-15) and a lower preoperative glomerular filtration rate (per 10 ml/minute/1.73 m(2) OR 0.78, 95% CI 0.67-0.91), and present with symptoms (any vs none OR 2.78, 95% CI 1.54-5.04) than those without conversion. The median postoperative glomerular filtration rate was 46 vs 61 ml/minute/1.73 m(2) in patients with vs without conversion.
Conversion to radical nephrectomy was rare in patients undergoing partial nephrectomy in this series. Increasing tumor size, central site, lower preoperative glomerular filtration rate and symptoms at presentation were associated with an increased risk of conversion, which increases the likelihood of chronic kidney disease postoperatively.
关于从部分肾切除术转为根治性肾切除术的信息很少。我们评估了在一组接受部分肾切除术的当代患者中转为根治性肾切除术的术中原因和预测因素。
我们确定了 2003 年至 2008 年间在我们机构接受开放或腹腔镜部分肾切除术并转为根治性肾切除术的所有患者。通过肾脏病饮食改良方程评估肾小球滤过率来评估肾功能。我们使用逻辑回归分析来确定肿瘤部位、肿瘤大小、体重指数、美国麻醉师协会评分、年龄或性别是否与转化风险相关。
转为根治性肾切除术的比率为 6%（1029 例患者中有 61 例）。在开放性部分肾切除术组中，865 例中有 59 例（7%，95%CI 5-9），腹腔镜部分肾切除术组中有 2 例（1.2%，95%CI 0.01-4）。转为根治性肾切除术的最常见原因是侵犯肾门结构、大小差异和残留肾功能不足。与未转为根治性肾切除术的患者相比，转为根治性肾切除术的患者肿瘤更大（每增加 1 厘米，OR 1.41，95%CI 1.24-1.59），肿瘤位于中央（中央与外周相比，OR 7.74，95%CI 3.98-15），术前肾小球滤过率较低（每增加 10 毫升/分钟/1.73 平方米，OR 0.78，95%CI 0.67-0.91），并伴有症状（任何症状与无症状相比，OR 2.78，95%CI 1.54-5.04）。与未转为根治性肾切除术的患者相比，转为根治性肾切除术的患者术后肾小球滤过率中位数为 46 毫升/分钟/1.73 平方米，而非 61 毫升/分钟/1.73 平方米。
在本系列中，接受部分肾切除术的患者转为根治性肾切除术的情况很少见。肿瘤大小增加、肿瘤位于中央、术前肾小球滤过率降低以及就诊时出现症状与转化风险增加相关，这增加了术后发生慢性肾脏病的可能性。
