Evaluate cTNM staging based on comprehensive imaging findings, and initially formulate treatment principles based on cTNM staging. Based on the invasion range determined by postoperative histology, pathological staging evaluation is performed. If there is deviation between pTNM and cTNM staging, postoperative treatment plan is revised according to pTNM staging results. I. Treatment of limited renal cancer Surgery is the preferred treatment for limited renal cancer. When radical nephrectomy is performed, the addition of regional or expanded lymph node dissection is not recommended. 1. Radical nephrectomy is the only method that is currently recognized as a possible cure for kidney cancer [18-20]. The classical radical nephrectomy includes: perinephric fascia, perinephric fat, affected kidney, ipsilateral adrenal gland, hilar lymph nodes and ureter above the iliac vessel bifurcation. The modern view is that radical nephrectomy with preservation of the ipsilateral adrenal gland can be chosen if the clinical stage is stage I or II, the tumor is located in the middle or lower part of the kidney, the tumor is <8 cm, and the preoperative CT shows normal adrenal gland [21-23]. However, in such cases, if the ipsilateral adrenal gland is found to be abnormal during surgery, the ipsilateral adrenal gland should be removed [24]. Radical nephrectomy can be performed via open surgery or laparoscopic surgery. Open surgery can be performed with either a transabdominal or transumbilical approach, and there is no evidence as to which surgical approach is more advantageous [25]. Radical nephrectomy has a mortality rate of approximately 2% [26] and a local recurrence rate of 1%-2% [27-29]. 2. preserved renal unit surgery is recommended to perform NSS according to various indications, and its efficacy is the same as radical nephrectomy [30-33]. the extent of renal parenchymal resection for NSS should be 0.5-1.0 cm from the tumor margin [34-36], and tumor enucleation is not recommended as an option for sporadic renal cancer [36-38]. In cases with intact normal renal tissue encircling the cut edge as observed by the naked eye, intraoperative cryopathological examination of the cut edge tissue is not necessary routinely [39,40].NSS can be performed via open surgery or laparoscopic surgery. The local recurrence rate after surgery with preserved renal units is 0-10%, while the local recurrence rate after surgery with tumors ≤4 cm is 0-3% [41]. The risk of potential recurrence after surgery needs to be explained to the patient. the mortality rate of NSS is 1-2% [41]. 3. laparoscopic surgery Surgical procedures include laparoscopic radical nephrectomy and laparoscopic partial nephrectomy. The surgical routes are divided into transabdominal, retroperitoneal and hand-assisted laparoscopic. The scope and standard of resection are the same as open surgery. Laparoscopic surgery is suitable for patients with limited renal cancer whose tumors are confined within the renal peritoneum, without surrounding tissue invasion and without lymphatic metastasis and venous tumor thrombosis, and its efficacy is comparable to that of open surgery [43, 44]. However, patients with stage ≥T3 renal cancer, a history of kidney surgery, and other non-surgical indications should be considered as contraindications to laparoscopic surgery. Laparoscopic surgery is also associated with a certain mortality rate. 4. Minimally invasive treatment radiofrequency ablation, high-intensity focused ultrasound and cryoablation for kidney cancer are in clinical research stage, and there is no evidence-based medical level I-III research results yet, so the long-term efficacy cannot be determined yet, so they should be selected strictly according to the indications and are not recommended as the first choice of surgical treatment. If such treatment is performed, it should be explained to the patient. Indications: those who are not suitable for open surgery, those who need to preserve the function of the renal unit as much as possible, those who have contraindications to general anesthesia, those with renal insufficiency, and those who have a requirement for less invasive treatment. Most studies consider it suitable for renal cancer <4 cm located in the periphery of the kidney [45, 46]. 5. Renal artery embolization can be used as a palliative treatment for patients who cannot tolerate surgical treatment. Preoperative renal artery embolization may be beneficial in reducing intraoperative bleeding and increasing the chance of radical surgery, but it has not been proven at the level of evidence I-III in evidence-based medicine. Renal artery embolization can cause complications such as puncture site hematoma, post-embolization infarction syndrome, and acute pulmonary infarction. It is not recommended for routine preoperative application. 6. postoperative adjuvant therapy There is no standard adjuvant treatment plan after surgery for limited renal cancer. pT1a renal cancer has a 5-year survival rate of more than 90% with surgical treatment, and adjuvant therapy is not recommended as a postoperative option. pT1b-pT2 stage renal cancer has metastases in about 20%-30% of patients within 1-2 years after surgery [47, 48]. Postoperative radiotherapy and chemotherapy cannot reduce the metastasis rate, and the routine application of adjuvant radiotherapy and chemotherapy after surgery is not recommended. Treatment of locally progressive renal cancer The preferred treatment for locally progressive renal cancer is radical nephrectomy, while resection of metastatic lymph nodes or hemangioma plugs needs to be chosen according to the extent of the lesion. There is no standard treatment plan after surgery. For patients with residual tumor after surgery, immunotherapy or difluorodeoxycytidine based chemotherapy or (and) radiotherapy is recommended [2]. While early studies advocated regional or expanded lymph node dissection, recent findings suggest that regional or expanded lymph node dissection is only practical for determining tumor stage in postoperative lymph node-negative patients; whereas regional or expanded lymph node dissection in lymph node-positive patients is only beneficial in a small number of patients, and requires combined immunotherapy or chemotherapy after surgery due to the presence of distant metastases. The combination of immunotherapy or chemotherapy is required after surgery because of the distant metastases. Most scholars believe that the TNM stage, the length of the tumor embolus, and whether the embolus infiltrates the vena cava wall are directly related to the prognosis [49]. Removal of inferior vena cava tumor emboli is recommended for patients with a clinical stage of T3bN0M0. This procedure is not recommended for patients with CT or MRI scans suggesting invasion of the inferior vena cava wall or with lymph node metastases or distant metastases. The mortality rate of vena cava aneurysm removal is approximately 9%. There is no uniform classification of venous aneurysm emboli. The MayoClinic classification is recommended [50]: grade 0: aneurysm is confined to the renal vein; grade I: aneurysm invades the inferior vena cava and the tip of the aneurysm is ≤2 cm from the opening of the renal vein; grade II: aneurysm invades the inferior vena cava below the level of the hepatic vein and the tip of the aneurysm is >2 cm from the opening of the renal vein; grade III: aneurysm grows up to the level of the inferior vena cava in the liver and below the diaphragm Grade IV: the tumor embolus invades into the inferior vena cava above the diaphragm. There is no standard adjuvant therapy after radical nephrectomy for locally progressive renal cancer, and multicenter, randomized controlled studies related to adjuvant IFN-α or (and) IL-2 therapy are ongoing and inconclusive. a randomized controlled study in Germany in 2004 [51] showed that adjuvant application of autologous tumor vaccine after surgery could improve the 5-year survival rate of patients with stage T3 renal cancer, but further confirmation in multicenter studies is needed. further confirmation from multicenter studies is needed. The National Pharmaceutical Administration has a strict access system for clinical trial treatment that must be strictly adhered to. Kidney cancer is a tumor that is insensitive to radiation, and radiotherapy alone cannot achieve better results. Preoperative radiotherapy is generally less used, and intraoperative or postoperative radiotherapy can be chosen for stage III kidney cancer that cannot be completely excised. Treatment of metastatic kidney cancer (clinical stage IV) There is no standard treatment plan for metastatic kidney cancer, and a comprehensive treatment mainly based on internal medicine should be adopted. Surgery is mainly an adjuvant treatment for metastatic kidney cancer, and very few patients can be cured by surgery. 1.Surgical treatment to remove the primary foci of kidney can improve the efficacy of IFN-α or (and) IL-2 in the treatment of metastatic kidney cancer. For patients with isolated metastases after radical nephrectomy and patients with renal cancer with isolated metastases, good behavioral status and low risk factors (see Table II-4), surgical treatment can be chosen. For patients with concomitant metastases, they may be treated simultaneously with renal surgery or in stages depending on the patient’s physical condition. For patients with renal tumor causing severe hematuria, pain and other symptoms, palliative nephrectomy and renal artery embolization can be chosen to relieve symptoms and improve survival quality. The mortality rate of metastatic renal cancer surgery is 2%-11%. 2.The results of randomized controlled study of internal medicine treatment cannot prove that LAK cells, TIL cells, and IFN-γ are effective in the treatment of metastatic kidney cancer. Currently IFN-α or (and) IL-2 is the first-line treatment option for metastatic kidney cancer treatment, with an efficiency of about 15%.