New surgical horizons: The role of cytoreductive nephrectomy for metastatic kidney cancer

Abstract

Renal cell carcinoma is the most lethal urologic malignancy. Up to 30% of patients with kidney cancer have metastatic disease and 30% of those treat-ed for local or locally advanced disease will progress to metastases. Radical nephrectomy is the standard treatment for the management of nondissemi-nated kidney cancer, but the role of cytoreductive nephrectomy for patients with metastatic disease is controversial. In this paper, the rationale for cytore-ductive nephrectomy is described and the currently available evidence for and against it is evaluated. The different approaches to defining prognostic fac-tors to select which patients will benefit from cytoreductive nephrectomy will also be described. Finally, the role of cytoreductive nephrectomy in the era of new targeted therapies is discussed. © 2007 Canadian Urological Association.