 Cytoriductive nephrectomy, CN, has long been considered as a standard treatment option for metastatic renal cell carcinoma, MRCC. However, recent studies have shown that it may not be necessary to perform CN when using targeted therapies such as sunatina. The two studies, Carmena and Surtime, compared the efficacy of sunatina balloon versus sunatina plus CN. Both studies found that there was no significant difference between the two groups in terms of PFS, however, the study conducted by Surtime showed a higher overall survival rate in patients who underwent deferred CN after three cycles of sunatina. These results suggest that CN should only be performed if needed, and that further prospective clinical trials and proper patient selection are required to determine its role in the current scenario. This article was authored by Luigi Napolitano, Celeste Manfredi, Luigi Cirillo, and others.