**14. Future directions and conclusions**

Surgery is the mainstay of therapy across renal cell carcinoma stages, and surgical innovation has resulted in less invasive approaches to localized disease while preserving oncologic efficacy. Renal cell carcinoma has become a model for solid tumors in which a better under‐ standing of biologic pathways has led to systemic therapies that have dramatically improved patient outcomes. Given the availability of multiple treatment options, each with a slightly different profile of risk and benefit, there are currently multiple options for therapy. The approach to treatment requires appreciation of the risks and benefits of each of these agents, as well as knowledge of the limitations of the current data.

The goal for every metastatic renal cell carcinoma patient upon presentation is to maximize overall therapeutic benefit, meaning delaying for as long possible a lethal burden of disease while maximizing quality of life and patient convenience.
