Nephrectomy is necessary in the treatment of metastatic renal cell carcinoma

Although we are observing a significant stage migration with an increasing number of patients being diagnosed with small renal masses confined to their kidney, roughly 20% of our patients have metastatic disease at the time of diagnosis. The therapeutic options available for this group of patients changed significantly during the last 5 years. The development and approval of new drugs for patients with disseminated disease forces us to re-evaluate the benefits associated with our previous therapeutic strategies. Although cytoreductive nephrectomy was largely accepted as a necessary step in the treatment of metastatic renal cell carcinoma (RCC), this concept is now challenged with the use of targeted therapy. Many believe we should abandon cytoreductive nephrectomy and adopt a pure systemic treatment approach. Before we endorse this concept, we must question the scientific rationale used in the past to justify performing cytoreductive nephrectomy and see if this rationale can be applied to targeted therapy.