Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Urology Department, Amasya University Medical School, Amasya, Turkey.
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
J Urol. 2017 Jul;198(1):30-35. doi: 10.1016/j.juro.2017.01.019. Epub 2017 Jan 10.
We sought to identify the preoperative factors associated with conversion from robotic partial nephrectomy to radical nephrectomy. We report the incidence of this event.
Using our institutional review board approved database, we abstracted data on 1,023 robotic partial nephrectomies performed at our center between 2010 and 2015. Standard and converted cases were compared in terms of patients and tumor characteristics, and perioperative, functional and oncologic outcomes. Logistic regression analysis was done to identify predictors of radical conversion.
The overall conversion rate was 3.1% (32 of 1,023 cases). The most common reasons for conversion were tumor involvement of hilar structures (8 cases or 25%), failure to achieve negative margins on frozen section (7 or 21.8%), suspicion of advanced disease (5 or 15.6%) and failure to progress (5 or 15.6%). Patients requiring conversion were older and had a higher Charlson score (both p <0.01), including an increased prevalence of chronic kidney disease (p = 0.02). Increasing tumor size (5 vs 3.1 cm, p <0.01) and R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and hilar location) score (9 vs 8, p <0.01) were also associated with an increased risk of conversion. Worse baseline renal function (OR 0.98, 95% CI 0.96-0.99, p = 0.04), large tumor size (OR 1.44, 95% CI 1.22-1.7, p <0.01) and increasing R.E.N.A.L. score (p = 0.02) were independent predictors of conversion. Compared to converted cases, at latest followup standard robotic partial nephrectomy cases had similar short-term oncologic outcomes but better renal functional preservation (p <0.01).
At a high volume center the rate of robotic partial nephrectomy conversion to radical nephrectomy was 3.1%, including 2.2% of preoperatively anticipated nephrectomy cases. Increasing tumor size and complexity, and poor preoperative renal function are the main predictors of conversion.
我们旨在确定与机器人辅助部分肾切除术转为根治性肾切除术相关的术前因素。我们报告了这一事件的发生率。
我们使用机构审查委员会批准的数据库，回顾性分析了 2010 年至 2015 年在我们中心进行的 1023 例机器人辅助部分肾切除术的数据。对标准组和转化组患者及肿瘤特征、围手术期、功能和肿瘤学结局进行比较。采用 logistic 回归分析识别转为根治性肾切除术的预测因素。
总体转化率为 3.1%（32/1023 例）。转为根治性肾切除术的主要原因是肿瘤累及肾门结构（8 例，25%）、冷冻切片检查未获得阴性切缘（7 例，21.8%）、怀疑疾病进展（5 例，15.6%）和手术无法进行（5 例，15.6%）。需要转为根治性肾切除术的患者年龄更大，Charlson 评分更高（均 p<0.01），包括慢性肾脏病的患病率增加（p=0.02）。肿瘤直径增大（5 厘米 vs. 3.1 厘米，p<0.01）和 R.E.N.A.L. 评分（9 分 vs. 8 分，p<0.01）也与转化风险增加相关。术前肾功能更差（OR 0.98，95%CI 0.96-0.99，p=0.04）、肿瘤较大（OR 1.44，95%CI 1.22-1.7，p<0.01）和 R.E.N.A.L. 评分增加（p=0.02）是转化的独立预测因素。与转化组相比，在最近的随访中，标准机器人辅助部分肾切除术的短期肿瘤学结局相似，但肾功能保存更好（p<0.01）。
在高容量中心，机器人辅助部分肾切除术转为根治性肾切除术的比例为 3.1%，其中包括 2.2%的术前预期肾切除术病例。肿瘤体积增大和复杂性增加，以及术前肾功能较差是转化的主要预测因素。
