Immediate Surgery or Surgery After Sunitinib Malate in Treating Patients With Metastatic Kidney Cancer

DISEASE CHARACTERISTICS:

* Histologically confirmed renal cell cancer (RCC)

  * Clear-cell subtype with a resectable asymptomatic in situ primary

    * Asymptomatic primary is defined as the absence of symptoms\* which can be exclusively assigned to the primary tumor such as flank pain and/or gross hematuria necessitating blood transfusion NOTE: \*Para-neoplastic symptoms cannot be assigned to the primary tumor alone in metastatic disease, they are not included in this definition.
    * No symptomatic primary tumor necessitating nephrectomy
* Resectable primary tumor

  * Bulky locoregional lymph node metastases larger than the primary tumor allowed provided resectability of the lymph nodes is surgically feasible
* Metastatic RCC

  * Distant metastases are not completely resectable at the time of surgery or during an additional intervention
  * No multiple distant lesions at one site
  * No bone-only metastases
* Measurable disease, both primary and metastatic, according to RECIST 1.1 criteria
* Planning to receive sunitinib malate as background therapy
* Patients with \> 3 of the following surgical risk factors are not eligible:

  * Serum albumin CTCAE v 4.0 grade 2 or worse
  * Serum LDH \> 1.5 times upper limit of normal
  * Liver metastases
  * Symptoms at presentation due to metastases
  * Retroperitoneal lymph node involvement
  * Supra-diaphragmatic lymph node involvement
  * Clinical stage T3 or T4 disease
* No clinical signs of CNS involvement

PATIENT CHARACTERISTICS:

* See Disease Characteristics
* WHO performance status 0-1
* Life expectancy \> 3 months
* WBC \> 3.0 x 10\^9/L
* Platelet count \> 100 x 10\^9/L
* Hemoglobin \> 10.0 g/dL
* PT/PTT or INR ≤ 1.2 times upper limit of normal (ULN)
* Bilirubin ≤ 1.5 times ULN
* ALT ≤ 2.5 times ULN (≤ 5 times ULN if liver lesions)
* Serum calcium \< 10.0 mg/dL
* Calculated or measured creatinine clearance \> 30 mL/min
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception 2 weeks before and during study treatment
* LVEF normal by MUGA scan or ECHO
* 12-lead ECG normal
* No serious cardiac illness (myocardial infarction and/or treatable or untreatable angina pectoris not responding to treatment) within the past 12 months
* No uncontrolled, high BP (≥ 150/100 mm Hg) despite optimal medical therapy
* No current pulmonary disease
* No active or uncontrolled infections, serious illnesses, malabsorption syndrome, or medical conditions, including patients with a history of chronic alcohol abuse, hepatitis, HIV, and/or cirrhosis
* No malignancies within the past 5 years except renal cell carcinoma, basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, resected incidental prostate cancer staged pT2 with Gleason Score ≤ 6 and postoperative PSA \< 0.5 ng/mL, or patients with any history of malignancies who are disease-free for more than 5 years
* No psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule

PRIOR CONCURRENT THERAPY:

* Prior local radiotherapy for bone lesions allowed
* No prior systemic therapy for metastatic RCC
* No prior partial or total nephrectomy
* No concurrent systemic corticosteroid and/or other immunosuppressive systemic therapies
* No concurrent radiotherapy, except palliative radiotherapy
* No concurrent participation in another clinical trial testing treatments for any disease including renal cell carcinoma
* No other concurrent investigational or systemic therapy for metastatic RCC