NARUS 2018: Contemporary Trends in the Surgical Approach for Radical Nephrectomy and Predictors of Open Conversion During Minimally Invasive Radical Nephrectomy
For this study, the authors used the National Cancer Database (NCDB) to identify all adult patients undergoing radical nephrectomy from 2010-2015. Kruskal-Wallis and Chi-squared tests were used to compare baseline characteristics between the converted and non-converted patients. Multivariable logistic models were used to identify factors independently associated with conversion.
There were 38,046 patients that were not converted to open and 2,138 converted to open (5.3%). Patients converted to open were more often African American, less likely to have a Charlson comorbidity score (CCS) of 0, less likely to be in the median income upper quartile, less likely to have a high school education, less likely to have private insurance, and more likely to have a larger tumor. The authors noted that there was an increase in utilization of robotic nephrectomy over the time period of the study: 1000 in 2010 to 3000 in 2015 captured in the NCDB. Factors associated with conversion to open on multivariable regression included age (OR 1.06), laparoscopic vs robotic approach (OR 1.3), higher CCS (OR 1.07) and tumor size < 5.5 cm vs >5.5 cm (OR 0.81).
The authors concluded that there has been a substantial increase in utilization of robotic assisted radical nephrectomy from 2010 to 2015. Compared to the robotic approach, laparoscopy was an independent predictor of open conversion. Although robotic radical nephrectomy is associated with higher costs compared to laparoscopic radical nephrectomy, the authors feel this difference should be considered in light of the reduced rate of conversion to open surgery with the robotic approach.
Presented By: Samarpit Rai, Department of Urology, University of Louisville School of Medicine, Louisville, KY
Co-Authors: Thomas M. FitzGibbon Jr, Adnan Dervishi, Jaimin Trivedi, Jamie C. Messer, Murali K. Ankem, Ahmed Q. Haddad
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md ,at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV