Defining the Role of Surgical Resection in Metastatic Renal Cell Carcinoma: A Mini Review

Ongoing advances in systemic therapy for metastatic renal cell carcinoma (mRCC) have left the role of surgical resection in this setting uncertain. In this mini review, we examine historical data and ongoing clinical trials evaluating the role of cytoreductive nephrectomy and metastasectomy in mRCC. We note that patients undergoing upfront nephrectomy may have a delayed opportunity to receive systemic therapy, which poses a significant risk, particularly for individuals with poor-risk or actively progressing disease. Although patients undergoing resection after response to systemic therapy have favorable outcomes, ongoing randomized trials will provide clarity regarding the role of deferred nephrectomy and metastasectomy in the context of current systemic regimens. PATIENT SUMMARY: In this mini review, we assess data on surgery to remove the primary tumor and its metastatic sites in kidney cancer. Drug options for metastatic kidney cancer have greatly improved, so there is a need to evaluate how surgery is used for these patients.