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

Authors :
Nicolas Branger
Nicolas Doumerc
Thibaut Waeckel
Pierre Bigot
Louis Surlemont
Sophie Knipper
Géraldine Pignot
François Audenet
Frank Bruyère
Alexis Fontenil
Bastien Parier
Cécile Champy
Morgan Rouprêt
Jean-Jacques Patard
François Henon
Gaëlle Fiard
Julien Guillotreau
Jean-Baptiste Beauval
Constance Michel
Simon Bernardeau
Fayek Taha
Richard Mallet
Frederic Panthier
Laurent Guy
Louis Vignot
Zine-Eddine Khene
Jean-Christophe Bernhard
Source :
European Urology Open Science, Vol 63, Iss , Pp 89-95 (2024)
Publication Year :
2024
Publisher :
Elsevier, 2024.

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, p = 0.009) and cT stage (OR: 2.22, 95% CI: 1.24–4.25, p = 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.

Details

Language :
English
ISSN :
26661683
Volume :
63
Issue :
89-95
Database :
Directory of Open Access Journals
Journal :
European Urology Open Science
Publication Type :
Academic Journal
Accession number :
edsdoj.797e0521da247119df28759150fded7
Document Type :
article
Full Text :
https://doi.org/10.1016/j.euros.2024.03.009