Kidney Cancer Research Network of Canada (KCRNC) consensus statement on the role of cytoreductive nephrectomy for patients with metastatic renal cell carcinoma

In recent decades, there have been significant advances in the systemic treatment options for patients with metastatic renal cell carcinoma (mRCC) with the introduction of targeted therapies and, more recently, immune checkpoint inhibition. Prior to the introduction of these contemporary therapies for mRCC, two randomized controlled trials identified a survival advantage to performing cytoreductive nephrectomy (CN) followed by interferon alpha-2b vs. interferon alpha-2b alone.1,2 However, whether CN, defined as nephrectomy in the setting of metastatic disease, provides a similar survival advantage for patients receiving modern systemic therapy has remained controversial, with two recent randomized trials calling into question the value of CN.3,4 In addition, several important questions remain surrounding the appropriate application of CN, particularly with regards to optimal patient selection and the timing of surgery. Herein, the Kidney Cancer Research Network of Canada (KCRNC) provides consensus recommendations on the role of CN in patients with mRCC in order to guide clinicians who manage patients with advanced RCC.