Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
Urology. 2021 Aug;154:170-176. doi: 10.1016/j.urology.2021.04.023. Epub 2021 May 5.
To compare perioperative outcomes between open conversion and planned open surgical approach and to investigate trends.
The National Cancer Database (NCDB) was queried for cT1 and cT2 RCC treated by radical (RN) or partial (PN) nephrectomy between 2010 and 2016. We retrospectively analyzed patient demographics, clinical tumor characteristics, and perioperative outcomes between unplanned open conversion and planned open approaches for RN and PN.
In total, 152,919 patients underwent RN or PN for cT1 or cT2 RCC over the 7-year span. The rate of unplanned open conversion from MIS was 3.9% overall, remaining lowest for cT1 PN (2.7%) and highest for cT2 RN (5.9%). Cases of open conversion tended to have higher rate of upstaged disease. When comparing open conversion to a planned open case, there was no difference in the length of post-operative hospitalization. On logistic regression, unplanned open conversion from MIS was associated with higher odds of positive margin for RN but not for PN. Increased odds of 30-day's readmission were associated with unplanned open conversion from MIS in the setting of cT1 PN only.
When compared to a planned open approach, conversion to open from MIS does not affect length of hospital stay but is associated with higher odds of positive surgical margins for RN and higher odds of 30-day's readmission for cT1 PN. Advanced pathologic stage is associated with an open conversion, likely relating to increased tumor complexity. These findings should be considered preoperatively when determining the best surgical approach.
比较开放式转化与计划开放式手术的围手术期结果，并探讨其趋势。
本研究通过国家癌症数据库（NCDB），检索了 2010 年至 2016 年期间接受根治性（RN）或部分（PN）肾切除术治疗的 cT1 和 cT2RCC 患者。我们回顾性分析了未计划开放式转化与计划开放式手术在 RN 和 PN 中患者的人口统计学、临床肿瘤特征和围手术期结果。
在 7 年的时间里，共有 152919 例患者接受了 cT1 或 cT2RCC 的 RN 或 PN。MIS 中转开腹的未计划发生率总体上最低，cT1PN 为 2.7%，cT2RN 为 5.9%；而开腹病例中疾病分期更高的比例更高。与计划开放病例相比，开腹病例的术后住院时间无差异。Logistic 回归分析显示，MIS 中转开腹与 RN 阳性切缘的几率增加相关，但与 PN 无关。在 cT1PN 中，MIS 中转开腹与 30 天再入院的几率增加相关。
与计划开放式手术相比，MIS 中转开腹不会影响住院时间，但与 RN 的阳性切缘几率增加和 cT1PN 的 30 天再入院几率增加相关。高级别病理分期与开放式转化相关，可能与肿瘤复杂性增加有关。这些发现应在术前确定最佳手术方式时考虑。
