In the treatment of metastatic lesions in advanced renal cell carcinoma (RCC), no clear consensus exists regarding whether immunotherapy should be combined with surgical resection or metastasectomy. Systemic therapies have significantly improved outcomes for advanced RCC patients and extended both progression-free and overall survival. However, complete disease eradication with drug therapy alone remains rare, and this limitation has renewed interest in metastasectomy for metastatic RCC. Although robust evidence is still lacking, many researchers have suggested that aggressive surgical approaches involving metastasectomy may improve survival in selected patients by controlling the cancer burden through the resection of primary and metastatic lesions. Novel immunotherapies have transformed solid tumor treatment, prompting a reevaluation of the role of metastasectomy. Recent studies have shown promise in combining systemic therapies with metastasectomy for metastatic RCC, emphasizing the need for further research and individualized, multidisciplinary approaches.