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Debate: upfront cytoreductive nephrectomy or not?

The EAU20 virtual meeting featured a thematic session looking at the controversy in renal cancer surgery considering the timing and necessity of cytoreductive nephrectomy. Prof. Axel Bex (The Royal Free London NHS Foundation Trust, UK) argued that cytoreductive nephrectomy should only be performed in selected patients after systemic treatment [1]. The counterpoint was provided by Prof. Antonio Finelli (University Health Network, Toronto, Canada) who argued in favour of upfront cytoreductive nephrectomy [2].

Prof. Bex commenced his debate by stressing that his arguments only apply to patients who require systemic therapy, such as those diagnosed with metastatic renal cell carcinoma (mRCC). There is evidence from 2 trials investigating the role and sequence of cytoreductive nephrectomy. The CARMENA trial randomised 450 patients equally to 1 of 2 arms: either upfront nephrectomy followed by adjuvan...



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