Oligoprogressive Renal Cell Carcinoma: What is the role of surgery?

Background: Oligoprogressive metastatic renal cell carcinoma (RCC) represents a unique clinical scenario where disease progression occurs in a limited number of disease sites while other lesions remain controlled by systemic therapy. Despite significant advances in targeted therapies and immunotherapy, complete remission is uncommon in this setting. Oligoprogression presents a therapeutic opportunity for local interventions. While stereotactic ablative body radiotherapy has gained prominence, the role of surgical metastasectomy remains unclear due to limited retrospective evidence and rapidly evolving treatment paradigms. Methods: A non-systematic search of PubMed/MEDLINE was performed in August 2025 including guidelines, reviews, and original studies. Additional sources were identified through manual reference screening. Results: Oligoprogression in RCC likely arises from clonal evolution dynamics, with spatially confined subclone mutations and microenvironmental niches yielding differential responses to treatment. Complete metastasectomy may offer a survival benefit, spare patients toxic side effects of systemic therapy, and offers the possibility of histopathological and molecular characterisation of residual disease. Surgery is also particularly important in delayed cytoreductive nephrectomy as the site of oligoprogression. However, this must be weighed against non-negligible surgical morbidity and complication rates. International guidelines recognise the role of surgical resection in the metastatic setting but emphasise low evidence levels and careful patient selection requirements. Conclusion: Limited evidence derived from the oligometastatic context constrains optimal patient selection and timing strategies in oligoprogressive RCC. Following the establishment of consensus over definitions and research gaps, future research integrating molecular biomarkers, novel imaging tracers, and multicentre collaborative studies will be essential to develop evidence-based surgical management protocols for this increasingly common clinical scenario.