Cytoreductive Nephrectomy and Metastasectomy for Renal Cell Carcinoma

Metastatic renal cell carcinoma (mRCC) has historically been associated with limited treatment options and poor prognosis. Based on data from two prospective trials in the cytokine immunotherapy era, cytoreductive nephrectomy (CN) was adopted as the standard of care in the multimodal treatment of patients with mRCC. More recently, targeted molecular therapies (TMTs) have shown improved outcomes as compared to cytokine immunotherapy and thus have become first line in the treatment of mRCC. While CN retains its role based on its historical value in the cytokine immunotherapy era, the available data in support of CN is less robust with newer TMTs. The field currently awaits the results of two trials evaluating the role of CN in the TMT era. Like CN, metastasectomy is also routinely used in the management of patients with mRCC and has mainly served to achieve surgical remission in patients with oligometastatic disease. This chapter will summarize the evidence supporting CN and metastasectomy in the treatment of mRCC.