“To Be or Not to Be Benign” at Partial Nephrectomy for Presumed RCC Renal Masses: Single-Center Experience with 195 Consecutive Patients

Abstract

In daily medical practice, an increasing number of kidney masses are being incidentally detected using common imaging techniques, owing to the improved diagnostic accuracy and increasingly frequent use of these techniques. As a consequence, the rate of detection of smaller lesions is increasing considerably. According to certain studies, following surgical treatment, up to 27% of small enhancing renal masses are identified as benign tumors at the final pathological examination. This high rate of benign tumors challenges the appropriateness of surgery for all suspicious lesions, given the morbidity associated with such an intervention. The objective of the present study was, therefore, to determine the incidence of benign tumors at partial nephrectomy (PN) for a solitary renal mass. To meet this end, a total of 195 patients who each underwent one PN for a solitary renal lesion with the intent to cure RCC were included in the final retrospective analysis. A benign neoplasm was identified in 30 of these patients. The age of the patients ranged from 29.9–79 years (average: 60.9 years). The tumor size range was 1.5–7 cm (average: 3 cm). All the operations were successful using the laparoscopic approach. The pathological results were renal oncocytoma in 26 cases, angiomyolipomas in two cases, and cysts in the remaining two cases. In conclusion, we have shown in our present series the incidence rate of benign tumors in patients who have been subjected to laparoscopic PN due to a suspected solitary renal mass. Based on these results, we advise that the patient should be counseled not only about the intra- and post-operative risks of nephron-sparing surgery but also about its dual therapeutic and diagnostic role. Therefore, the patients should be informed of the considerably high probability of a benign histological result.

Characteristics of the Patients Aged Less than 40 Years Operated for a Renal Mass

“…Several studies conducted on young adults reported similar results regarding the types of benign lesions (23,24,26). The diagnosis of RCC and the decision for surgery primarily depended on radiological imaging methods.…”

“…In most cases, these radiological imaging methods successfully diagnosed RCC, but occasionally they faced challenges in differentiating oncocytoma and lipid-poor AML from RCC (12)(13)(14). In the general population, the detection rate of benign tumors in patients who had surgery for RCC was reported as being around 11-16% (23)(24)(25). Aslan et al conducted a study evaluating localized renal masses in patients aged <40 years, and reported that 24% of the patients were diagnosed with benign lesions (26).…”

“Could Patient Age and Gender, along with Mass Size, Be Predictive Factors for Benign Kidney Tumors?”: A Retrospective Analysis of 307 Consecutive Single Renal Masses Treated with Partial or Radical Nephrectomy

“…The choice of PN makes it possible to reduce the risk of performing radical surgery (with the consequent removal of the kidney) in the case of benign neoplasia, although the latter may have larger diameters. With respect to this, in our previous research [19], the medical records of patients undergoing laparoscopic PN at our department over the last 10 years were retrospectively reviewed, including a total of 195 patients. The analysis result was that 30 (15.4%) of the 195 kidney lesions removed were diagnosed as benign by the pathologist, with a complication rate of 10% (3/30 cases) among these patients.…”