Cytoreductive Nephrectomy in Advanced Renal Cell Carcinoma

Dr. Voss and Dr. Serzan discuss how the practical considerations surrounding cytoreductive nephrectomy can differ depending on the first-line regimen used in advanced renal cell carcinoma (RCC). Dr. Serzan explains that surgery may be more logistically straightforward for patients receiving maintenance nivolumab, whereas patients receiving IO-TKI combinations require careful coordination around holding tyrosine kinase inhibitor therapy because of considerations such as wound healing and bleeding risk. The experts then highlight ongoing prospective studies designed to clarify the role of cytoreductive and other consolidative approaches in metastatic RCC, including the PROBE, NORDIC-SUN, and SAMURAI trials. Dr. Voss notes that these studies are evaluating strategies such as surgery and radiotherapy in patients receiving contemporary systemic therapy. Dr. Serzan emphasizes that current decisions are often informed by retrospective data and anecdotal experience, underscoring the need for prospective evidence before these approaches can be routinely incorporated into standard practice.