@ronsale, it can be hard to know which treatment you would tolerate best. I would ask many questions of both the surgeon and the oncologist so you can get answers specific to your medical history and current health status as well as age consideration.
- What are the benefits of each treatment?
- What are the side effects?
- Do I have any current conditions that make one treatment more suited to me than the other?
- How is recovery from a nephrectomy in my age group with my health status?
- Keytruda can cause severe side effects in some people. What do you do if I experience side effects that I cannot tolerate?

Keytruda is an effective treatment for many different cancer types. You can find a number of discussions dedicated to Keytruda by using the search. See the search results here: https://connect.mayoclinic.org/search/discussions/?search=Keytruda

In these discussions, you'll find members who had to stop treatment after the first dose and another who ran a marathon after completing a full course of treatment. That's why I suggest talking to your cancer team to learn as much as you can about risks and benefits tailored to you. They don't have a crystal ball of course, but they can guide an informed decision.

Do you have any other medical conditions that need to be considered in your decision?