| ObjectiveIntraoperative conversion to open surgery was a common surgical strategy when minimally invasive surgery(MIS)for renal tumors was not progressing well.This study aimed to investigate outcomes and preoperative risk factors for intraoperative open conversion(OC)and to develop a preoperative predictive model to estimate the risk of the individual patient with PN.MethodsThe patients with renal tumors treated with minimally invasive surgery(MIS)including partial nephrectomy and radical nephrectomy from January 2020 to December 2021 were included.Indicators involved in the statistics included gender,age,body mass index and other relevant variables.Preoperative laboratory data included hemoglobin,platelets(PLT),eGFR and other relevant variables.Imaging features included tumor size,RENAL score,Mayo Adhesion Probability(MAP)score and other relevant variables.Surgery-related information included ASA score,surgical approach,type of surgery and other relevant variables.In addition to this,the nature of the tumor,surgical margins,operative time,blood transfusion,postoperative hospital days,hospital costs and reasons for conversion to open surgery were also counted.The endpoint was whether the intraoperative conversion from minimally invasive to open surgery occurred.Univariate logistic regression analysis was performed on the partial nephrectomy cohort to examine 26 variables preoperatively,and multivariate logistic regression analysis was performed to identify independent risk factors.A nomogram was created based on independent risk factors for the PN cohort and additional retrospective collection of data from January 2022 to November 2022 was used as a validation dataset for internal validation.Perioperative outcomes of patients participating in the study were analyzed.To adjust for the effect of covariates on treatment choice,a 1:1 propensity score-matched(PSM)cohort was created using all available clinical variables to analyze perioperative outcomes in the intermediate and non-intermediate groups,including tumor benignity,surgical margins,operative time,blood transfusion status,postoperative hospital days,and hospital costs.ResultsA total of 680 patients who met the study criteria were enrolled in the study.There were 384 patients in the partial nephrectomy cohort and 296 patients in the radical nephrectomy cohort.The incidence of OC was 6.47%(44/680)and the incidence of conversion to open was 6.77%(26/384)in the partial nephrectomy cohort and 6.08%(18/296)in the radical nephrectomy cohort.Independent predictors for the occurrence of conversion to open in the partial nephrectomy cohort were RENAL score(p<0.001),and MAP score(p<0.001).A predictive model was constructed and 129 PN patients were retrospectively collected for internal validation.The C-indexes for the nomogram prediction model and validation set were 0.882(95%IC:0.827-0.936)and 0.855(95%IC:0.750-0.961),respectively,and the calibration plots show that the predicted and actual transit opening probabilities are a good fit.The calibration plots showed that the predicted and actual conversion to open probabilities were better fitted.Analysis of the radical nephrectomy cohort showed statistically significant differences in age(p=0.026),history of abdominal surgery(p=0.006),RENAL score(p=0.002)and MAP score(p=0.001)between the two groups.After PSM,perioperative outcomes were analyzed in a total of 40 patients in the intermediate and non-intermediate groups,which showed a longer postoperative hospital stay in the intermediate open group(p=0.001).ConclusionsRENAL score and MAP score were independent predictors of OC.This study provides novel and feasible nomogram to assess the risk of OC in patients by preoperative factors,in addition,propensity score matching analysis showed that patients with intermediate open surgery had longer postoperative hospital stay,necessitating preoperative prediction to further assist clinicians in making appropriate clinical decisions for patients with renal tumors. |
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