In patients with locally advanced renal cell carcinoma (RCC), simultaneous lymph node dissection (LND) and radical nephrectomy (RN) is controversial. Of the two studies addressing this issue, one randomized study showed no benefit of LND and the other non-randomized one showed better survival for extended LND. In patients with clinically enlarged lymph nodes, LND could be useful for better staging and local control of the disease. Targeted drug therapy trials will probably help us to better define high-risk patients who can benefit from LND in near future. Until now, no randomized study compared RN alone vs. RN plus adrenalectomy yet. Large tumors and upper pole location may help to predict adrenal involvement. However, no clear recommendation is made in the guidelines in 2015.