Mai există un rol pentru nefrectomia citoreducţională în era terapiilor ţintite şi a imunoterapiei

Metastatic renal cell carcinoma, the sixth most frequent cancer diagnosis worldwide, was until recently a disease without many effective therapeutic options. Clinical re­ports of stable disease or even complete regression of the metastatic lesions after nephrectomy raised the question of the role of cytoreductive nephrectomy in the metastatic setting. This paper aims to provide a brief overview of the evidence behind cytoreductive nephrectomy in stage IV renal cell carcinoma in the era of targeted therapy and im­mu­no­therapy, presenting the conclusions of most im­por­tant clinical trials in the field, with their strengths and limitations, starting in 2001, with two randomized phase III trials arguing for cytoreductive nephrectomy (Southwest Oncology Group 8949, and the European Organization for Research and Treatment of Cancer 30947), followed by two important trials that showed a reduced benefit of this strategy (CARMENA final results, presented in 2019, and SURTIME, published in 2017). A summary of the current guidelines of both oncological and urological main societies is also presented, together with a discussion of what the future will bring in this important field of uro-oncology.