This paper adds to our knowledge in two highly important and frequently discussed topics at multidisciplinary team meetings. Should patients with metastatic renal cancer undergo an operation? And if they do how long does it take them to recover? This is a large-scale retrospective audit from an institution with a quaternary referral practice and as such merits publication. The conclusions are not surprising, showing age and a high Karnofsky Performance Status as poor prognostic factors and the potential to delay subsequent therapy. However, as the study spans two ground-breaking changes in the treatment of renal cancer, i.e. the introduction of laparoscopy for surgeons and anti-angiogenic agents for oncologists, we await the publication of prospective studies to determine what influence if any these novel treatments will have on the two fundamental questions posed above.