Yes, the standard procedure for Stage IV is to remove the primary wherever possible, and then tackle the mets (usually with drugs, but sometimes by surgery or other 'physical' techniques such as ablation - if they are the right number, the right size and in the right place).
Usually the primary is only not removed if the patient is too weak for surgery at that time, there are other health complications that would compromise surgery, or the tumour has grown into places that make surgery very risky (I read here a while back about one patient who had two surgeons - one renal one for the kidney and one cardiac surgeon for where the tumour had grown up veins and arteries!)(and the surgery was successful, it's great to say).
In that case the patient is put on drug therapy first to seek to shrink the primary and/or get them 'well enough' to undergo surgery (which can happen very successfully, as Steve and I know others here can testify).
As to whether surgery improves what happens with the mets, my husband was told that pre-Sutent et al, the data showed an improved outcome for patients when the primary was removed, but that there was not yet enough data in for the new drugs like Sutent to be able to call it one way or the other.
I think in each case it's essential to try and find out what the onc actually thinks is the likely outcome for each patient. ie, is the onc saying 'we won't take the primary out because we think you are doing fine as it is, and drugs are holding you stable and keeping you alive, so why rock the boat?' which is arguably very reasonable thing to say OR - and this is what you have to watch out for, in my opinion! - is the 'subtext' of the onc not recommending removing the primary actually 'You're a gonner so why bother?'
That's unacceptable - ie, unacceptable for the onc to make that call. The patient can make it if they want, and many patients do decide not to undergo 'horrible' treatment but let the cancer take its course. However, surely no patient should take that decision lightly, or, in particular, without at least one other 'second opinion' from another oncologist.
Oncologists DO vary in how they view their patients, what they think their chances are, how prepared they are to lose patients without a maximum fight, how ready they are to accept death sooner rather than later (for the patient, that is!). It can be very personal, I feel, depending on the oncologist's inner character.
But, in my opinion, in the end it is NOT the oncologist's decision to make - it is the patient's, because it is the patient's life at stake. Their life, their call.
Which is why each of us needs maximum information - and from several sources (some oncs do NOT like being challenged or questioned!!!!!).
As to the severity of the nephrectomy surgery, that depends on lots of factors, such as, obviously, the age and overal health of the patient, and also on the location and size of the primary tumour. My husband's had grown so large that it was eating into his liver and his diaphragm, so it was, yes, major surgery indeed (brilliantly done!), and because cutting out a piece of the diapghram went into the lung cavity, he ended up in ICU for several days with a lung drain.
However, his overall state of health for a middle aged man was extremely fit, and he was well enough recovered to drive himself home on the Friday after having had the surgery on the Monday evening.....He was mobile at home again very swiftly, out for walks and cycle rides, and went on a windsurfing holiday within two months....so yes, major surgery, but an excellent recovery. (Very sadly, the brain mets carried him off by Christmas, but that's another story)
All the very best, whatever treatment option you go for.
Julie.