Cytoreductive nephrectomy is a surgical procedure to remove all or part of your kidney to treat cancer that has spread to distant locations.

“Cytoreductive” surgeries are procedures that reduce the number of cancer cells. Nephrectomy is the complete removal of a kidney.

Cytoreductive nephrectomy is a treatment option for people with good overall health and limited spread of kidney cancer to distant locations. Cancer that has spread to distant areas is known as metastatic cancer.

Sometimes, doctors use a cytoreductive nephrectomy or partial nephrectomy for non-metastatic cancers. For example, doctors may perform this procedure to reduce symptoms such as blood in your urine and pain.

Read on to learn more about how cytoreductive nephrectomy treats metastatic kidney cancer and when doctors may recommend it.

Cytoreductive nephrectomy is the removal of a kidney to treat metastatic kidney cancer. If only part of your kidney is removed, the procedure is called a partial cytoreductive nephrectomy. Removal of the entire kidney is also called a radical cytoreductive nephrectomy.

Cytoreductive nephrectomy by itself or combined with other treatments such as immunotherapy or targeted therapy might aim to:

  • reduce your symptoms
  • prolong your life
  • slow the spread of your cancer

Almost all metastasized kidney cancers are considered incurable.

Historically, an immediate cytoreductive nephrectomy was the standard of care for people with metastatic kidney cancer. With the growing development of immunotherapy and targeted therapy for treating advanced cancers, cytoreductive nephrectomy is no longer as widely performed.

Results of the CERMENA and SURTIME trials

The CERMENA and SURTIME trials were two phase 3 clinical trials that found evidence against the use of cytoreductive nephrectomy for some people.

The results of the CERMENA trial were published in the New England Journal of Medicine in 2018.

In this study, the researchers compared the survival of 450 people with intermediate- or poor-risk metastatic kidney cancer who received either:

  • the targeted therapy drug sunitinib alone
  • sunitinib with a cytoreductive nephrectomy

The researchers found that half of the people who received sunitinib alone lived 18.4 months compared to 13.9 months in people who received both treatments.

In the SURTIME trial, researchers compared the progression-free survival of people given:

  • immediate cytoreductive nephrectomy followed by sunitinib
  • sunitinib followed by cytoreductive nephrectomy.

The results of this study suggest that it might be more effective to start with sunitinib and only perform a cytoreductive nephrectomy if the cancer doesn’t progress.

Benefits of a cytoreductive nephrectomy

The results of the CERMENA and SURTIME trials suggest that cytoreductive nephrectomy may be beneficial for:

  • improving symptoms such as:
    • blood in urine
    • pain
    • uncontrolled high blood pressure
  • improving the outlook for some people after first receiving targeted therapy
  • treating people with cancer spread to only 1–3 locations, a group underrepresented in the CARMENA trial
  • improving the outlook in people who don’t require targeted therapy in combination with treatment to target the areas where cancer has spread

Current recommendations for the use of cytoreductive nephrectomy

The results of the CARMENA and SURTIME trials have led to a shift in the recommendations for cytoreductive nephrectomy. It’s generally no longer recommended for people with more than one of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria:

  1. less than 1 year between diagnosis and the start of systemic therapies like targeted therapy
  2. decreased hemoglobin levels
  3. elevated leukocyte (white blood cell) count
  4. elevated platelet count
  5. difficulty performing daily tasks (Karnosky performance status under 80%)
  6. elevated blood calcium levels (hypercalcemia)

Partial versus radical cytoreductive nephrectomy

In a 2020 study, researchers found that partial cytoreductive nephrectomy improved survival in adults over the age of 65 with metastatic kidney cancer compared to radical nephrectomy, especially in males with:

  • a tumor smaller than 7 centimeters
  • no spread to lymph nodes
  • isolated spread to distant organs

Other treatments for metastatic kidney cancer

Other treatment options for metastatic kidney cancer include:

  • external beam radiation therapy to reduce symptoms
  • targeted therapy and immunotherapy drugs such as:
    • nivolumab with ipilimumab or cabozantinib
    • pembrolizumab with axitinib or Lenvatinib
    • avelumab with axitinib
    • cabozantinib
    • sunitinib
    • pazopanib
    • sorafenib
    • temsirolimus
    • bevacizumab with or without the cytokine interferon alpha
  • cytokines such as:
    • interferon-alpha
    • interleukin-2
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Cytoreductive nephrectomy is an extensive procedure that requires general anesthesia.

Your surgeon can perform the procedure using an open or laparoscopic approach. An open surgery involves removing your kidney through a large incision made with a scalpel. A laparoscopic approach is less invasive and involves using a long, thin tube called a laparoscope and a smaller incision.

A laparoscopic procedure can take from 2–3 hours.

According to the Canadian Cancer Society, potential side effects include:

About 13.7% of people in the United States diagnosed with kidney cancer from 2011–2020 had metastatic kidney cancer. Overall, people with kidney cancer lived at least 5 years 77.6% as often as people in the general population. People with metastatic kidney cancer only lived 5 years about 17.4% as often.

In the CARMENA trial, researchers found that half of people with poor- to intermediate-risk metastatic kidney lived 13.9 months after receiving sunitinib with a cytoreductive nephrectomy.

Cytoreductive nephrectomy involves removing your kidney to treat kidney cancer that has spread to distant locations. Doctors may perform this to reduce your symptoms or in combination with targeted therapy or immunotherapy to prolong your life.

Advances in immunotherapy and targeted therapy drugs have decreased the use of cytoreductive nephrectomy. It may still help reduce symptoms and benefit people whose cancer has spread to only a few areas.