Comprehensive characterization of the perioperative morbidity of cytoreductive nephrectomy

The authors report a single institution retrospective analysis of the reported complications and delay to initiation of systemic therapy in a cohort of 294 patients with metastatic renal cell carcinoma (1). This is the largest series evaluating this novel study question. There is presently no randomized controlled data in the era of targeted therapy demonstrating a survival benefit of upfront cytoreductive nephrectomy (CN). Despite this, CN is commonly utilized in well selected patients utilizing extrapolated data from the immunotherapy era. There is some evidence from the National Cancer Database, that adoption of CN from 2005–2008 (era of targeted therapy) actually has been decreasing with improvement in the effectiveness and enhanced reported toxicity profile of targeted therapy (2). Questions remain regarding which patients derive optimal benefit from CN.