The cTNM stage is evaluated by comprehensive imaging results, and the treatment principles are initially formulated according to the cTNM stage. If there is any deviation between the pTNM and cTNM stages, the postoperative treatment plan will be revised according to the pTNM stage 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. Radical nephrectomy is the only method that has been recognized as a possible cure for kidney cancer. The scope of classical radical nephrectomy includes: perinephric fascia, perinephric fat, affected kidney, ipsilateral adrenal gland, hilar lymph nodes and ureter above the bifurcation of iliac vessels. In modern opinion, if the clinical stage is 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, radical nephrectomy with preservation of the ipsilateral adrenal gland can be chosen. However, in this case, if the ipsilateral adrenal gland is found to be abnormal during surgery, the ipsilateral adrenal gland should be removed. Radical nephrectomy can be performed by open surgery or laparoscopic surgery. Open surgery can be performed with either a transabdominal or transumbilical approach, and there is no evidence to suggest which approach is more advantageous. The mortality rate of radical nephrectomy is about 2%, and the local recurrence rate is 1%-2%. 2. nephron sparing surgery (NSS) NSS is recommended for various indications and its efficacy is the same as radical nephrectomy.The extent of parenchymal resection for NSS should be 0.5-1.0 cm from the tumor margin, and tumor enucleation is not recommended for sporadic renal cancer [36-38]. For cases with intact normal renal tissue encircling the incisional margin as observed by the naked eye, intraoperative histopathological examination of the incisional margin is not necessary routinely.NSS can be performed by 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 to 2%. Indications for NSS: renal cancer occurs in patients with anatomically or functionally isolated kidneys where radical nephrectomy would result in renal insufficiency or uremia, such as congenital isolated kidneys, contralateral renal insufficiency or nonfunction, and bilateral renal cancer. Relative indications for NSS: Patients with certain benign diseases in the contralateral kidney of kidney cancer, such as kidney stones, chronic pyelonephritis or other diseases that may lead to deterioration of kidney function (such as hypertension, diabetes, renal artery stenosis, etc.). The indications and relative indications for NSS are not specifically limited to tumor size. Indications for NSS can be selected: clinical stage T1a (tumor ≤4cm), tumor located in the periphery of the kidney, single asymptomatic kidney cancer, and normal contralateral kidney function. 3. Laparoscopic surgery Surgical approaches include laparoscopic radical nephrectomy and laparoscopic partial nephrectomy. The surgical route is 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 to 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. However, patients with stage ≥T3 renal cancer, previous history of kidney surgery and other non-surgical indications should be considered as contraindications to laparoscopic surgery. Laparoscopic surgery also has a certain mortality rate. 4.Minimally invasive treatment Radio-frequency ablation (RFA), high-intensity focused ultrasound (HIFU) and cryoablation are in the clinical research stage, and there is no evidence-based level I-III research results for the treatment of kidney cancer. The long-term efficacy of these treatments cannot be determined yet, so they should be carefully selected according to the indications and are not recommended as the first choice for 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 require 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 For patients who cannot tolerate surgical treatment can be a palliative treatment for symptomatic relief. 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 treatment There is no standard adjuvant treatment plan after surgery for localized renal cancer. pT1a renal cancer has a 5-year survival rate of more than 90% with surgical treatment, and postoperative adjuvant treatment is not recommended. pT1b~pT2 stage renal cancer has metastasis 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 (trade name gemcitabine, keyselect) based chemotherapy or (and) radiotherapy are recommended. Early studies advocated regional or expanded lymph node dissection, while recent findings suggest that regional or expanded lymph node dissection is only practical for determining tumor stage in postoperative lymph node-negative patients, while regional or expanded lymph node dissection is only beneficial in a small number of lymph node-positive patients, who require 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. 2.Surgical treatment of inferior vena cava thrombosis Most scholars believe that the TNM stage, the length of the thrombus, and whether the thrombus infiltrates the vena cava wall are directly related to the prognosis. It is recommended that patients with clinical stage T3bN0M0 should have inferior vena cava tumor embolus removal. 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 Mayo Clinic's five-grade classification is recommended: Grade 0: the tumor is confined to the renal vein; Grade I: the tumor invades the inferior vena cava, and the tip of the tumor is ≤2 cm from the opening of the renal vein; Grade II: the tumor invades the inferior vena cava below the level of the hepatic vein, and the tip of the tumor is >2 cm from the opening of the renal vein; Grade III: the tumor grows to the level of the inferior vena cava in the liver and below the level of the diaphragm; Grade IV: the tumor invades the inferior vena cava in the liver. below; Grade IV: tumor embolus invades into the inferior vena cava above the diaphragm. There is no standard adjuvant treatment protocol 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 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 Removal of primary foci in 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, it may be possible to proceed 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.Medical treatment The results of randomized controlled study cannot prove that LAK cells, TIL cells and IFN-γ are effective in the treatment of metastatic kidney cancer. At present, IFN-α or (and) IL-2 is the first-line treatment option for metastatic kidney cancer treatment, with an efficiency of about 15%.