Arora S, et al. - Researchers probed into the incidence and factors exerting an impact on the conversion from robot-assisted partial nephrectomy (RAPN) to radical nephrectomy. The findings shed light on the connection between RAPN with a low rate of conversion. Body mass index and Charlson score were reported to be the independent predictors of conversion. No link was determined between the tumor factors such as clinical stage, location, multifocality, or RENAL score with increased risk of conversion.

Methods

• Recruitment consisted of 501 patients who underwent attempted RAPN between November 2014 and February 2017 by 22 surgeons at 14 centers in nine countries within the Vattikuti Collaborative Quality Initiative database.
• Herein, patients were permanently logged for RAPN prior to surgery and were assessed on an intention-to-treat basis.
• Experts carried out multivariable logistic regression with backward stepwise selection of variables in order to contemplate the factors linked with conversion to radical nephrectomy.

Results

• It was determined that the overall conversion rate was 25/501 (4.99%).
• Candidates converted to radical nephrectomy were found to be older (median age [interquartile range] 66.0 [61.0-74.0] vs 59.0 [50.0-68.0], P=0.012), presenting with a higher body mass index (median 32.8 [24.9-40.9] vs. 27.8 [24.6-31.5] Kg/m², P=0.031), higher age-adjusted Charlson comorbidity score (median 6.0 [4.0-7.0] vs. 4.0 [3.0-5.0], P < 0.001), higher American Society of Anesthesiologists score (Score ≥3; 13/25 (52.0%) vs 130/476 (27.3%), P=0.021), Preoperative estimated glomerular filtration rate (P=0.141), clinical tumor stage (P=0.145), tumor location (P=0.140), multifocality (P=0.483) and RENAL nephrometry score (P=0.125) did not exhibit any notable variation between the groups.
• Multivariable analysis unveiled that the independent predictors for conversion were BMI (odds ratio [95% CI]; 1.070 [1.018-1.124]; P=0.007), and Charlson score (odds ratio [95% CI]; 1.459 [1.179-1.806]; P=0.001).