Few cases of patients requiring an upgrade from a partial to a radical nephrectomy are reported. This study comprehensively evaluates the preoperative risk factors and outcomes associated with partial-to-radical nephrectomy conversions in a single institution in the modern era. From 2000 to 2015, patients who had a partial nephrectomy that was later converted (cases) were matched with patients whose partial nephrectomy was never converted (controls) for statistical purposes. Nephrometry scores were determined by looking at preoperative imaging and using the RENAL system (for radius, exophytic/endophytic characteristics, anterior/posterior descriptor, and placement relative to the polar line). The operative reports were mined for the reasons behind the changes. A multivariate conditional logistic regression analysis was used to determine preoperative risk variables for conversion. About 680 cases (6.1%t of all partial nephrectomies) were found and matched with 688 controls based on tumor size, year of surgery, and surgical method. A drop from 13% in 2000-2003 to 4% in 2012-2015 may be seen in the conversion rate. Over half of the claimed reasons for the change were oncological in nature, including worries about upstaging and positive margins. Multivariate analyses showed that male gender (odds ratio 2.34; P =.03), a higher Charlson score (odds ratio per 1-unit increase: 1.28; P =.03), a posterior or middle (on the anteroposterior axis) location (compared to the anterior, odds ratio 2.83; P =.02 and odds ratio 6.38; P<.001), and a hilar location (compared to the peripheral/central odds ratio 5.61; P<.001) were associated with increased odds of conversion. Researchers’ experience suggests that the conversion rate from partial to radical nephrectomy is modest and declining. After adjusting for tumor size, preoperative factors, including hilar, posterior, and middle placements, were strongly associated with conversions and provided direction for operational planning and patient counseling.

Source: auajournals.org/doi/full/10.1097/JU.0000000000002837