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.
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.
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.
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.
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.
European urology open science. 2024 Mar 28*** epublish ***
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
Department of Urology, Institut Paoli Calmettes, Marseille, France., Department of Urology, CHU Toulouse, Toulouse, France., Department of Urology, CHU Caen, Caen, France., Department of Urology, CHU Angers, Angers, France., Department of Urology, CHU Rouen, Rouen, France., Department of Urology, Hopital européen Georges Pompidou, Paris, France., Department of Urology, CHU Tours, Tours, France., Department of Urology, CHU Nîmes, Nîmes, France., Department of Urology, Hopital Bicêtre, Paris, France., Department of Urology, Hopital Henri Mondor, Créteil, France., GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France., Department of Urology, CH Mont-de-Marsan, Mont-de-Marsan, France., Department of Urology, CHU Lille, Lille France., Department of Urology, CHU Grenoble, Grenoble, France., Department of Urology, Clinique Pasteur, Toulouse, France., Department of Urology, Clinique Croix du Sud, Toulouse, France., Department of Urology, Hopital Saint-Joseph, Paris France., Department of Urology, CHU Poitiers, Poitiers, France., Department of Urology, CHU Reims, Reims, France., Department of Urology, Polyclinique Francheville, Périgueux, France., Department of Urology, Hopital Tenon, Paris, France., Department of Urology, CHU Clermont-Ferrand, Clermont-Ferrand, France., Department of Urology, CHU Nice, Nice, France., Department of Urology, CHU Rennes, Rennes, France., Department of Urology, CHU Bordeaux, Bordeaux, France.