In this landmark study 246 patients with metastatic kidney cancer including patient with renal vein or vena cava extension were randomized to either nephrectomy (cytoreductive) plus IFN alpha-2b or IFN alone. The mean age was 59 and follow up was 1 year. There was an overall survival benefit in favor of the surgery group of 11.1 months v 8.1 months for patients only given IFN. Surgery was performed first followed by cytokine therapy 2-4 weeks later when the patient had recovered. Cytoreductive nephrectomy has become the standard of care in patients with metastatic kidney cancer with resectable primary tumors.