Nephrectomy has become an integral part of the management of patients with metastatic kidney cancer. In the past, nephrectomy was performed in this setting only in certain circumstances mostly to relieve pain or as a response to intractable bleeding. But indications that some patients had spontaneous regression of their metastatic disease following nephrectomy, and the fact that the primary tumor rarely, if ever, responded to systemic therapy, prompted more widespread integration of nephrectomy into the management of patients with metastatic disease.
Performing nephrectomy in patients with advanced kidney cancer is not without risk, however. The very real chance of significant metastatic disease progression during the postoperative period or complication before or during surgery that may prolong postoperative recovery could potentially delay or prevent the administration of systemic therapy in the postoperative period. Patient selection for surgery remains critical for success. Patients should be good candidates for surgery, and have a relatively small tumor that can be impacted significantly by surgery. Patients with complicating factors, including extensive metastases to the liver, brain, or bones, may not be good candidates for surgery because of their poor overall prognosis.
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