为最坏情况做准备：微创肾肿瘤手术中开放转换的管理及预测因素（UroCCR - 135研究）

Preparing for the Worst: Management and Predictive Factors of Open Conversion During Minimally Invasive Renal Tumor Surgery (UroCCR-135 Study).

作者信息

Branger Nicolas, Doumerc Nicolas, Waeckel Thibaut, Bigot Pierre, Surlemont Louis, Knipper Sophie, Pignot Géraldine, Audenet François, Bruyère Frank, Fontenil Alexis, Parier Bastien, Champy Cécile, Rouprêt Morgan, Patard Jean-Jacques, Henon François, Fiard Gaëlle, Guillotreau Julien, Beauval Jean-Baptiste, Michel Constance, Bernardeau Simon, Taha Fayek, Mallet Richard, Panthier Frederic, Guy Laurent, Vignot Louis, Khene Zine-Eddine, Bernhard Jean-Christophe

机构信息

Department of Urology, Institut Paoli Calmettes, Marseille, France.

Department of Urology, CHU Toulouse, Toulouse, France.

出版信息

Eur Urol Open Sci. 2024 Mar 28;63:89-95. doi: 10.1016/j.euros.2024.03.009. eCollection 2024 May.

DOI:10.1016/j.euros.2024.03.009

PMID:38585592

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10997889/

Abstract

BACKGROUND AND OBJECTIVE

Data regarding open conversion (OC) during minimally invasive surgery (MIS) for renal tumors are reported from big databases, without precise description of the reason and management of OC. The objective of this study was to describe the rate, reasons, and perioperative outcomes of OC in a cohort of patients who underwent MIS for renal tumor initially. The secondary objective was to find the factors associated with OC.

METHODS

Between 2008 and 2022, of the 8566 patients included in the UroCCR project prospective database (NCT03293563), who underwent laparoscopic or robot-assisted minimally invasive partial (MIPN) or radical (MIRN) nephrectomy, 163 experienced OC. Each center was contacted to enlighten the context of OC: "emergency OC" implied an immediate life-threatening situation not reasonably manageable with MIS, otherwise "elective OC". To evaluate the predictive factors of OC, a 2:1 paired cohort on the UroCCR database was used.

KEY FINDINGS AND LIMITATIONS

The incidence rate of OC was 1.9% for all cases of MIS, 2.9% for MIRN, and 1.4% for MIPN. OC procedures were mostly elective (82.2%). The main reason for OC was a failure to progress due to anatomical difficulties (42.9%). Five patients (3.1%) died within 90 d after surgery. Increased body mass index (BMI; odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.09, = 0.009) and cT stage (OR: 2.22, 95% CI: 1.24-4.25, = 0.008) were independent predictive factors of OC.

CONCLUSIONS AND CLINICAL IMPLICATIONS

In MIS for renal tumors, OC was a rare event (1.9%), caused by various situations, leading to impaired perioperative outcomes. Emergency OC occurred once every 300 procedures. Increased BMI and cT stage were independent predictive factors of OC.

PATIENT SUMMARY

The incidence rate of open conversion (OC) in minimally invasive surgery for renal tumors is low. Only 20% of OC procedures occur in case of emergency, and others are caused by various situations. Increased body mass index and cT stage were independent predictive factors of OC.

摘要

背景与目的

大型数据库报告了肾肿瘤微创手术（MIS）期间开放手术转换（OC）的数据，但未对OC的原因及处理进行精确描述。本研究的目的是描述一组最初接受肾肿瘤MIS患者的OC发生率、原因及围手术期结局。次要目的是找出与OC相关的因素。

方法

2008年至2022年期间，在UroCCR项目前瞻性数据库（NCT03293563）纳入的8566例接受腹腔镜或机器人辅助微创部分（MIPN）或根治性（MIRN）肾切除术的患者中，163例经历了OC。与每个中心联系以了解OC的背景情况：“急诊OC”意味着存在一种无法通过MIS合理处理的直接危及生命的情况，否则为“择期OC”。为评估OC的预测因素，在UroCCR数据库上使用了2:1配对队列。

主要发现与局限性

所有MIS病例的OC发生率为1.9%，MIRN为2.9%，MIPN为1.4%。OC手术大多为择期（82.2%）。OC的主要原因是因解剖困难导致手术无法推进（42.9%）。5例患者（3.1%）在术后90天内死亡。体重指数（BMI）升高（比值比[OR]：1.05，95%置信区间[CI]：1.01 - 1.09，P = 0.009）和cT分期（OR：2.22，95% CI：1.24 - 4.25，P = 0.008）是OC的独立预测因素。