Factor Analysis of Intraoperative Radical Conversion During Partial Nephrectomy - Single Surgeon Experience

다국어 초록 (Multilingual Abstract)

Purpose: Preoperative aspects and dimensions used for an anatomical (PADUA) classification is useful to predict perioperative complications and warm ischemia time. However, it remains uncertain whether PADUA classification can predict intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN). We evaluate whether PADUA classification parameters can predict conversion to RN during PN. Materials and Methods: We retrospectively assessed data of 593 patients who underwent open PN and robotic PN for renal tumors by a single surgeon at a single tertiary center between December 2003 and September 2017. Intraoperative conversion to RN was performed in 17 of 593 patients who initially underwent PN. We evaluated the factors influencing the surgical modalities including PN and radical conversion cases. Then, the factors significantly associated with conversion to RN were further analyzed. Results: There were no significant differences between the 2 groups in age, longitudinal location, exophytic rate, and rim or face locations of renal masses. Renal sinus involvement, urinary collecting system involvement, and renal mass size were variables that predicted radical conversion, using univariate analysis. Renal sinus involvement (odds ratio [OR], 9.075; p=0.049) and urinary collecting system involvement (OR, 3.944; p=0.029) were independent predictors of intraoperative radical conversion, using multivariate analysis. Conclusions: The PADUA classification is a useful tool to predict intraoperative conversion from PN to RN. Renal sinus involvement and urinary collecting system involvement are the best predictors of intraoperative conversion from PN to RN.

참고문헌 (Reference)

1 Okhunov Z, "The comparison of three renal tumor scoring systems: C-Index, P.A.D.U.A., and R.E.N.A.L. nephrometry scores" 25 : 1921-1924, 2011

2 Kutikov A, "The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth" 182 : 844-853, 2009

3 Patard JJ, "Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience" 171 (171): 2181-2185, 2004

4 Long JA, "Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes" 61 : 1257-1262, 2012

5 Wang AJ, "Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of ＞100 consecutive procedures" 73 : 306-310, 2009

6 Li L, "Risk of chronic kidney disease after cancer nephrectomy" 10 : 135-145, 2014

7 Thompson RH, "Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy" 179 : 468-471, 2008

8 Hayn MH, "RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy" 108 : 876-881, 2011

9 Ficarra V, "Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery" 56 : 786-793, 2009

10 Huang WC, "Partial nephrectomy versus radical nephrectomy in patients with small renal tumors: is there a difference in mortality and cardiovascular outcomes?" 181 : 55-61, 2009

11 Licht MR, "Nephron sparing surgery for renal cell carcinoma" 149 : 1-7, 1993

12 Galvin DJ, "Intraoperative conversion from partial to radical nephrectomy at a single institution from 2003 to 2008" 185 : 1204-1209, 2011

13 Long JA, "External validation of the RENAL nephrometry score in renal tumours treated by partial nephrectomy" 111 : 233-239, 2013

14 Ellison JS, "Association of RENAL nephrometry score with outcomes of minimally invasive partial nephrectomy" 20 : 564-570, 2013

15 Minervini A, "Analysis of surgical complications of renal tumor enucleation with standardized instruments and external validation of PADUA classification" 20 : 1729-1736, 2013

16 Van Poppel H, "A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma" 59 : 543-552, 2011