The impact of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma (RCC) is discussed herein with consideration of prolonged survival and quality of life. A nephrectomy can be indicated in a patient with good performance status and pulmonary metastases when adjuvant immunotherapy is an option. In contrast, in a patient with poor performance status and/or metastases including multiple organs, a nephrectomy is not indicated. To relieve symptoms, options other than nephrectomy should be considered.