Presentation Authors: Ted Vellos*, Daniel C. Rosen, David J Paulucci, Alp T. Beksac, John P. Sfakianos, Ketan K. Badani, New York, NY
Introduction: Conversion to an open approach is an inherent risk associated with minimally invasive surgery (MIS) including partial (PN) and radical nephrectomy (RN). We sought to evaluate the incidence and to identify predictors of conversion from MIS to open PN and RN.
Methods: The National Cancer Database was queried to identify 27,102 patients that underwent MIS-PN for cT1-2N0-M0 kidney cancer or MIS-RN for a cT1-4N0-1M0-1 kidney cancer from 2010-2014. Multivariable binary logistic regression models were used to identify predictors of patient, tumor, hospital and surgery specific variables associated with conversion from MIS to open surgery.
Results: The rate of conversion to from MIS to open surgery was found to be 3.0% (n=777) for PN and 5.5% (n=1,314) for RN (Table I). Factors associated with conversion to open PN in multivariable analysis include laparoscopic vs. robotic approach (OR=2.97; 95% CI=2.53, 3.46; p < .001), lower procedural volume (OR 2.53; CI=2.03, 3.17; p < .001), PN at academic/integrated network vs. community hospitals (OR=1.49 CI=1.25,1.81 p < .001), and earlier year of surgery (OR=0.94; CI=0.89, 0.99 p=.037). Factors associated with conversion to open RN include larger tumor size higher cT stage (OR=1.43; CI=1.18, 1.71; p < .001), cN+ (OR=1.76; CI=1.08,2.79; p=.019), performing a lymph node dissection (OR=1.26; CI=1.06, 1.48; p=.009), lower procedural volume (OR=1.38; CI=1.19, 1.59) p < .001), and earlier year of surgery (OR=0.95; CI=0.91,0.99) p=.007).
Conclusions: These data suggest that a robotic approach at higher volume centers may be associated with a decreased likelihood of conversion to open surgery compared to laparoscopy. Overall, conversion to open surgery is a decreasingly common but not exceptional event, and appropriate counseling and preparation is warranted.