Renal cell carcinoma has a very heterogeneous behavior. Nearly 30% of the patients are metastatic at the time of diagnosis and approximately 50% of the patients will develop metastases or recurrence after nephrectomy for an apparently localized disease. No prognostic factor is at the moment absolutely reliable in predicting the outcome for an individual patient. Nephrectomy in the presence of metastases is often performed by urologic surgeons in an attempt to prolong life or to improve the quality of life. Induction of spontaneous regression of metastases is very rare and it is still not proven that nephrectomy enhances the response to any systemic therapy. The resection of a solitary metastasis can be beneficial to a few patients although cure remains uncommon. Since no other effective treatment is actually available, metastasectomy can be advocated in a selected group of patients.