Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma – Current Concepts and Contentions in the Era of Immune Checkpoint Inhibitors

Cytoreductive nephrectomy (CN), or the removal of the primary kidney tumor in the setting of metastatic disease, plays a critical role in the treatment of metastatic renal cell carcinoma (mRCC). The benefits of CN, are multifactorial including alleviating symptoms but also eliminating cells potentially prone to future metastasis, and potentially extending a patient's survival. As innovations in mRCC treatment continue to emerge, the importance and timing of CN in patient care remains the subject of ongoing debate in the scientific community. With advancements in modern therapies and the introduction of immune checkpoint inhibitors (ICI), the optimal integration of CN in mRCC management becomes even more important to investigate. This manuscript reviews the key literature related to CN and critically evaluates data that investigated CN efficacy. Furthermore, this article summarizes data to help identify ideal candidates for CN, and explores options for integrating CN within the contemporary systemic therapy landscape.