The nephron-sparing partial nephrectomy has become the gold standard in the surgical therapy of small renal tumors (4-7 cm). In metastased renal cell cancers it is reasonable to perform a nephrectomy or a partial nephrectomy in combination with cytokine-therapy (clear cell type) and/or a targeted therapy with Angiogenesis-Inhibition, in presence of a Karnofsky-Index > 70%. A surgical standard procedure for organ-confined renal cell cancers and an immunological standard therapy for metastased renal cell cancers are no more proper; in fact nowadays exists a spectrum of different efficient therapies. Surgery in metastased diseases is indicated if it can improve the quality of life of the patient.