The ideal objective of any surgical program is cure. This communication will not concern itself with the circumstances in which nephrectomy may be palliative in patients with renal cell cancer. That ablative surgery may have value in the palliation of some symptoms, such as pain and fever, and in the cure of others, such as hematuria, is known. Only problems relating to surgical efforts to remove all local cancer in anticipation of cure will be reviewed.
Any judicious decision regarding management of patients with renal cell cancer entails a knowledge of the natural history of the untreated tumor (which includes modes and rate of spread) and of the risks and the advantages of therapeutic alternatives. For example, if all renal cell cancers metastasized only by blood stream, there would be no reason for node dissection, and if there were no possibility of invasion of perirenal fat and fascia, simple nephrectomy