Bhindi B, et al. - The aim of authors was to compare overall survival (OS) between patients with metastatic renal cell carcinoma ((mRCC) receiving initial cytoreductive nephrectomy (iCN) with or without subsequent targeted therapy (TT) and initial TT (iTT) with or without subsequent CN. Data support CN as the initial approach for mRCC in appropriate surgical candidates, taking into account the greater likelyhood of receiving multimodal therapy and an associated OS benefit.