Inclusion Criteria:  Renal masses ≥ cT2 (by any conventional imaging). N1 or M1 disease is allowed if they are deemed surgical candidates (including cytoreductive nephrectomy). Male and female patients. 18 and older. Ejection fraction (EF) ≥ 45% by echocardiogram (ECHO).  Adequate organ function as defined by:  Hemoglobin ≥ 9 g/dL. Pre-operative allogenic blood transfusion is allowed. Platelets ≥ 100.000/μl. Albumin ≥ 2.5 g/dL. Aspartate Aminotransferase (AST) and alanine transaminase (ALT) ≤ 75U/L or total bilirubin ≤ 2.0 mg/dL. WBC within institutional normal limits. PT within institutional normal limits. INR < 1.5 and PTT normal. Consent and compliance with all aspects of the study protocol.  Exclusion Criteria:  Male and female younger than 18 years old. Non-surgical candidate Unstable angina.