Kidney cancer is one of the common urological tumors. When the tumor is confined to the kidney, the kidney tumor can be removed through radical surgery to obtain better results. Once the tumor metastasizes, such as to lymph nodes, lungs or bones, which is often referred to as advanced tumor, the treatment will be more difficult. Does it still work to remove the kidney tumor then? Renal tumor removal surgery for metastatic patients is also called subtractive nephrectomy. Although the surgical procedure is the same as radical resection for limited kidney cancer, the results are very different. Previously, due to the poor effect of kidney cancer drug treatment, subtractive nephrectomy became one of the main means of traditional treatment for advanced kidney cancer. Due to the great progress in drug therapy for kidney cancer in recent years, new targeted drugs and immunomodulatory drugs can significantly improve the survival of some patients with advanced kidney cancer. Some studies have found that drug therapy alone can achieve the same effect as surgery, therefore, it is proposed that patients with advanced kidney cancer can be treated with drug therapy instead of subtractive nephrectomy. Nevertheless, the summary results of bulk clinical data show that resection of renal tumors can still prolong the survival of some patients on the basis of comprehensive treatment. The challenge is to distinguish which patients will benefit from surgery. It is generally believed that patients with few metastatic organs and sites and in good health can be considered for subtractive nephrectomy, with adjuvant new drug therapy before and after surgery, and in some patients, concomitant resection of metastases can be considered.