THE ROLE OF SURGERY FOR LOCO-REGIONAL AND ADVANCED UROLOGICAL CANCERS: Edited by Declan Murphy and Derya TilkiRole of cytoreductive surgery in the era of immunotherapyIsali, Ilahaa,b; Braun, Averyc; Bukavina, Lauraa,b,d; Psutka, Sarah P.e Author Information aUrology Institute, University Hospitals Cleveland Medical Center bCase Western Reserve University School of Medicine, Cleveland, Ohio cDepartment of Urology, Einstein Medical Center dDepartment of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania eDepartment of Urology, University of Washington School of Medicine, Seattle, Washington, USA Correspondence to Sarah P. Psutka, MD, MS, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195, USA. Tel: +1 206 598 0861; e-mail: [email protected] Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-urology.com). Current Opinion in Urology 32(6):p 618-626, November 2022. | DOI: 10.1097/MOU.0000000000001037 Buy SDC Metrics Abstract Purpose of review The benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) was first called into question in the tyrosine kinase inhibitors (TKIs) era. It remains undefined in the context of the recent development and approval of immune checkpoint inhibitors (ICIs) and level one evidence supporting the rapid adoption of dual ICI and combination ICI + TKI therapeutic approaches for mRCC. Our objective is to synthesize the available contemporary data regarding the safety, feasibility, and oncologic outcomes with CN for mRCC in the age of immunotherapy as well as to highlight trials in progress that will address this key knowledge gap. Recent findings Data from the SURTIME and CARMENA trials provided insight to guide patient selection for CN in patients with mRCC receiving TKI-based treatment strategies. At present, there is a body of retrospective data supporting the safety and oncologic efficacy of CN in carefully selected patients with mRCC in both the upfront and delayed setting. The results of ongoing trials evaluating the safety and feasibility for CN as well as optimal patient selection and sequencing strategies are eagerly awaited. Summary Although the optimal selection criteria and timing for CN remains to be established for patients with mRCC in the immunotherapy era, the available body of evidence underscores the importance of careful patient selection. Ongoing prospective studies, such as Cyto-KIK, PROBE, and NORDIC-SUN, will better define the role of CN in the rapidly evolving treatment landscape for mRCC. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.