[1_TD$DIFF]EAU [2_TD$DIFF]Recommendation The Role of Cytoreductive Nephrectomy: [3_TD$DIFF]European [4_TD$DIFF]Association [5_TD$DIFF]of [6_TD$DIFF]Urology Recommendations in 2016 Axel Bex a, * ,y , Bo ¨rje Ljungberg b,y , Hein van Poppel c,z , Thomas Powles d,y , on behalf of the European Association of Urology a Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; b Department of Surgical and Perioperative Sciences, Urology and Andrology, Umea ˚ University, Umea ˚, Sweden; c Department of Urology, University Hospitals of the KULeuven. Leuven, Belgium; d The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK 1. EAU guidelines on cytoreductive nephrectomy The European Association of Urology (EAU) renal cell carcinoma (RCC) guidelines panel compiles and regularly updates clinical guidelines to provide urologists and oncologists with evidence-based information and recom- mendations for the management of RCC [1]. The RCC guidelines are based on systematic reviews performed between 2012 and 2015 that are updated using structured literature assessment of studies published since the date of the last search for the systematic reviews. The recom- mendations are based on the highest available level of evidence, but the current evidence base for cytoreductive nephrectomy (CN) is limited [1]. Tumour nephrectomy is potentially curative only if all tumour deposits can be excised. For most patients with metastatic disease, CN is palliative and systemic treatments are necessary. In a meta-analysis comparing CN plus immunotherapy versus immunotherapy alone, increased long-term survival was found in patients treated with CN [2]. For CN combined with targeted agents, such as sunitinib or sorafenib, only retrospective confounded data are available, including one systematic review with meta-analysis [3–12] (Table 1). CN is currently recommended in metastatic RCC (mRCC) patients with good performance status (PS), large primary tumours, and low metastatic volume. CN is not recom- mended in patients with poor PS or International Metastatic Renal-Cell Carcinoma Database Consortium EUROPEAN UROLOGY 70 (2016) 901–905 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted July 1, 2016 Associate Editor: James Catto Keywords: Renal cell cancer Management Metastatic Nephrectomy Cytoreductive Performance score EAU Guidelines [1_TD$DIFF]Abstract Patient summary: After the introduction of systemic targeted therapies, the use of nephrectomy in patients with metastatic renal cell carcinoma has declined. Currently, systemic therapy is offered to more patients first as a means to select those candidates that will likely benefit from removal of their primary tumour. Although studies consis- tently demonstrate a survival benefit after nephrectomy, most patients with poor risk metastatic disease are unlikely to benefit from surgery. Soon studies will report on the effect of nephrectomy in patients with metastatic disease at diagnosis. # 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved. y EAU Renal Cell Cancer Guidelines Panel z EAU Executive Board member, Adjunct Secretary General–Education * Corresponding author. Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Tel. +31 020 512 2553; Fax: +31 020 512 2554. E-mail address: a.bex@nki.nl (A. Bex). http://dx.doi.org/10.1016/j.eururo.2016.07.005 0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.