# Avoidable Benign Kidney Tumor Resections—Data from a Tertiary Care Cancer Institute

## TL;DR

This study finds that a small percentage of kidney tumor surgeries at a cancer institute were for benign tumors, suggesting potential overtreatment.

## Contribution

The study provides the first data on benign kidney tumor resection rates in an Indian tertiary cancer institute.

## Key findings

- Benign kidney tumor resection rate was 4.8% in the study population.
- No patient or imaging characteristics could reliably predict benign tumor pathology.
- Asymptomatic benign tumors ≤7 cm accounted for 3.0% of resections, indicating potentially unnecessary surgeries.

## Abstract

Enhancing renal masses are conventionally treated as malignant unless proven otherwise due to the difficulty distinguishing between malignant and benign tumors based on imaging. Data from the Western registries suggests overtreatment of renal tumors with a Benign Kidney Tumor Resection Rate (BKTRR) ranging from 10 to 33%, with an increasing trend. Since robust, population-based data from India was unavailable, we sought to determine BKTRR in an apex cancer institute, which would provide insight into the rates in the community. The institutional kidney tumor database was queried for all patients aged ≥18 years with renal neoplasms between January 2000 and December 2022. Patients who underwent surgery, either radical or partial nephrectomy, with intent to cure were analyzed and the BKTRR during the study period was evaluated. A total of 330 patients underwent surgery for renal tumors presumed to be malignant. A final pathologic diagnosis of the benign tumor was made in 16 (4.8%) patients, comprising 7.2, 7.2, and 3.7% of resections with LTD ≤4, 4–7, and >7 cm, respectively. Asymptomatic benign tumors ≤7 cm comprised 3.0% of all resections, and these were potentially unnecessary surgeries. A multivariable analysis suggested that no patient or imaging characteristic could predict a final benign extirpative pathology. Our study suggests a lower rate of BKTRR compared to the published international literature but is likely to be the lower limit of that in the community. Population-based studies are required to determine the true BKTRR and the quantum of potentially unnecessary surgeries for benign kidney tumors.