Decision-Making Regarding Conversion from Partial to Radical Nephrectomy in MUSICKIDNEY
Recommended Citation
Wilder S, Butaney M, Wilder S, Wang Y, Hijazi M, Gandham D, Van Til M, Goldman B, Qi J, Mirza M, Johnson A, Rudoff M, Wenzler D, Rogers CG, Lane BR. Decision-Making Regarding Conversion from Partial to Radical Nephrectomy in MUSICKIDNEY. J Endourol 2023; 37:A163-A164.
Document Type
Conference Proceeding
Publication Date
9-1-2023
Publication Title
J Endourol
Abstract
Introduction: Partial nephrectomy (PN) has emerged as the standard of care for localized small renal masses. Its use has expanded to include larger and more complex masses, with increasing potential for conversion to radical nephrectomy (RN). Limited data exists regarding specific reasons for conversion to RN. We evaluated incidence and reason for conversion in patients undergoing robotic PN (RPN) using data from a statewide quality improvement (QI) collaborative. Methods: MUSIC-KIDNEY maintains a prospective statewide registry of newly diagnosed T1RM. All patients with a plan to undergo RPN at initial visit with the urologic surgeon were queried and then stratified based on actual procedure performed (RPN vs. RN). Pre-operative and intra-operative records were obtained for each patient to confirm conversion from RPN to RN, determine preoperative assessment of PN difficulty, and assess reason for conversion. Patient, tumor, and practice variables were obtained via the MUSIC registry and compared between cohorts via Wilcoxon rank sum test. Pathologic data and postoperative renal function were assessed. Results: A total of 650 patients were identified with an initial plan to undergo RPN. The rate of conversion from RPN to RN was 4.7% (27/650). No open conversions were documented. Patients undergoing conversion had larger (4.4 cm vs 2.8 cm) and higher complexity (63.0% with intermediate/high RENL score vs 51.6%) tumors. Patients who underwent conversion had significantly higher rates of pT3/T4 disease (28% vs 8.7%, p = 0.006) and lower postoperative renal function (Cr 1.3 vs 1.0, p < 0.001). Review of the 27 cases that underwent conversion found that 24 conversions were performed due to tumor complexity and/or oncologic concerns for locally-advanced disease, with only 5 (0.9%) conversions secondary to intraoperative bleeding. Only 63.0% (17/27) of converted cases had preoperative documentation regarding assessment of PN difficulty and/or likelihood of conversion. 88% (15/17) of converted cases with preoperative documentation available indicated increased surgical complexity ('PN vs. RN', 'complicated PN, etc.). Conclusions: MUSIC-KIDNEY has identified a low rate of conversion (< 5%) from RPN to RN within the collaborative that likely reflects the increased proportion of surgeries for tumors with increased oncologic risk, in which the plan may better be termed PN vs. RN. The rate of intraoperative conversion for uncontrolled bleeding was < 1%. These findings provide further data to justify the safety of PN, even in higher complexity tumors. We have identified QI opportunities to standardize preoperative documentation regarding PN difficulty, and multiple initiatives within MUSIC-KIDNEY exist to improve this and other aspects of surgical care for patients with renal masses.
Volume
37
First Page
A163
Last Page
A164
