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Role of surgery in patients with metastatic renal cell carcinoma

Jerome P Richie, MD, FACS
Toni K Choueiri, MD
Section Editor
Michael B Atkins, MD
Deputy Editors
Michael E Ross, MD
Wenliang Chen, MD, PhD


Patients who present with metastatic renal cell carcinoma (RCC) or who develop metastases or recurrent disease following prior treatment are generally managed with systemic therapy, primarily using immunotherapy or agents targeting the vascular endothelial growth factor (VEGF) pathways. However, not all patients with metastatic RCC behave similarly; some data suggest that there may be a subgroup whose tumors will display an indolent growth pattern that may warrant careful surveillance rather than active surgical or medical therapy [1]. Regardless, most patients with metastatic RCC will require treatment, and surgery is sometimes part of the therapeutic plan.

This topic will discuss the role of surgery in patients with metastatic RCC. Other topics relevant to this population are discussed separately. (See "Overview of the treatment of renal cell carcinoma", section on 'Advanced RCC'.)


Surgery continues to play an important role in the management of patients with metastatic renal cell carcinoma (RCC) in one of several ways (algorithm 1):

A nephrectomy can be performed as part of a combined modality approach in order to decrease the bulk of tumor prior to systemic therapy (see 'Nephrectomy' below)

Metastasectomy, in patients with one or a very limited number of metastases (see 'Metastasectomy' below)

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Literature review current through: Nov 2017. | This topic last updated: Nov 15, 2016.
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