DOI: https://doi.org/10.36347/sasjs.2026.v12i08.002

Pages: 650-654

Cytoreductive nephrectomy (CN) has been a cornerstone of multimodal management of metastatic renal cell carcinoma (mRCC) since the cytokine era. However, the advent of targeted therapies and, more recently, immune checkpoint inhibitor (ICI)-based combination regimens has prompted a critical re-evaluation of its role, timing, and patient selection. The CARMENA trial demonstrated noninferiority of sunitinib alone compared with upfront CN followed by sunitinib, while the SURTIME trial suggested that deferred CN may be preferable to immediate surgery. In the ICI era, no prospective randomized data are yet available, but multiple large retrospective analyses and a pooled FDA analysis suggest a persistent survival benefit for CN in carefully selected patients. Current guidelines from the NCCN, EAU, and ASCO reflect this nuanced landscape, recommending individualized decision-making with emphasis on risk stratification, tumor burden, and response to initial systemic therapy. Ongoing phase III trials, NORDIC-SUN, PROBE (SWOG-1931), and SEVURO-CN, are expected to provide definitive evidence. This mini review synthesizes the current evidence and guideline recommendations to inform clinical practice.