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Cross et al. J Cancer Metastasis Treat 2021;7:55 Journal of Cancer
DOI: 10.20517/2394-4722.2021.99
Metastasis and Treatment

Review Open Access

Comparison of immediate vs. deferred cytoreductive
nephrectomy in patients with synchronous

metastatic renal cell carcinoma

Brian W. Cross, Michael S. Cookson
Department of Urology, University of Oklahoma, Oklahoma City, OK 73104, USA.
Correspondence to: Dr. Michael S. Cookson, Department of Urology, University of Oklahoma, 920 SL Young Blvd, WP 2140,
Oklahoma City, OK 73104, USA. E-mail: michael-cookson@ouhsc.edu

How to cite this article: Cross BW, Cookson MS. Comparison of immediate vs. deferred cytoreductive nephrectomy in patients
with synchronous metastatic renal cell carcinoma. J Cancer Metastasis Treat 2021;7:55. https://dx.doi.org/10.20517/2394-
4722.2021.99

Received: 20 Apr 2021 First Decision: 19 May 2021 Revised: 7 Jun 2021 Accepted: 29 Jun 2021 Published: 5 Sep 2021

Academic Editor: Hendrik Van Poppel Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Cytoreductive nephrectomy has been a mainstay in treating patients with synchronous metastatic renal cell
carcinoma (mRCC) for over two decades. It was supported in part by level 1 evidence that showed improved
survival for patients undergoing radical nephrectomy before initiation of systemic therapy dating back almost 20
years. Since that time, the landscape of systemic therapy for mRCC has shifted mainly from IL-2 based therapy to
tyrosine kinase inhibitors (TKIs) targeting the vascular endothelial growth factor pathway, and now to
immunotherapy with PD-L1 inhibitors. Given the significant advancements in systemic therapy for patients with
mRCC, the role of cytoreductive nephrectomy and sequencing of treatment has been questioned. Recent
randomized studies appear to disprove the theory that upfront cytoreduction improves overall survival, particularly
in the TKI era, and thus treating physicians are faced with conflicting data to guide treatment decisions. The role of
cytoreductive nephrectomy is in evolution, and so is the timing of surgery in selected patients. Familiarity with
available evidence coupled with patient selection and targeted therapy should help to inform decision-making.
Currently, an initial course of systemic therapy followed by consideration of nephrectomy in those with a favorable
response may be the most prudent algorithm outside the context of a clinical trial.

Keywords: Metastatic kidney cancer, immediate vs. delayed cytoreductive nephrectomy, survival

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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