The role of surgery in advanced renal cell carcinoma: cytoreductive nephrectomy and metastasectomy.

Renal cell carcinoma (RCC) is considered a relatively rare malignancy worldwide. Around a third of patients with RCC present with metastatic disease, and among those patients treated with nephrectomy with curative intent, more than one-third develop metastases during postoperative follow-up. Due to the absence of curative medical treatments for metastatic RCC, surgery remains the mainstay of therapy. Surgery plays a key role in two aspects: cytoreductive nephrectomy to remove the primary renal tumor in the presence of known metastatic disease, and metastasectomy to remove distant metastatic foci in patients with metastatic RCC.