What Is Cytoreductive Nephrectomy?

Cytoreductive nephrectomy is a type of kidney cancer surgery where the entire kidney is removed even though the cancer has already spread to other parts of the body. The goal is not to cure, but to reduce the overall tumor burden and improve the effectiveness of other treatments, such as immunotherapy or targeted therapy.

This surgery is generally considered in stage 4 kidney cancer, where the cancer has metastasized (spread) to the lungs, bones, liver, or elsewhere.

Why Do It?

Removing the kidney may:

• Lower the number of cancer cells in the body
• Help other treatments work better
• Relieve pain or bleeding caused by the tumor
• Improve overall survival in selected patients

Cytoreductive nephrectomy is typically followed by systemic treatment, such as:

• Immunotherapy (e.g., nivolumab, pembrolizumab)
• Targeted therapy (e.g., cabozantinib, lenvatinib)

It is not suitable for everyone. Doctors consider several factors before recommending it:

• The patient’s overall health and fitness for surgery
• Extent and location of metastases
• Whether the patient is likely to benefit from systemic therapy after surgery
• Response to initial systemic therapy, if started before surgery

In some cases, doctors may begin with drug treatment first and consider surgery only if the patient responds well. This is called a deferred cytoreductive nephrectomy.

Risks and Considerations

This is a major surgery, and recovery may take longer than for localized kidney cancer. Risks include bleeding, infection, and post-operative complications, especially in patients who are already unwell.
Still, in the right patients, cytoreductive nephrectomy can help control symptoms, extend life, and improve response to treatment.

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