Management of bone metastases from Renal Cell Carcinoma (RCC) has significantly changed after the era of targeted therapy that improved the overall survival. This has sucked the different interveners in their management to push the surgical indications in order to improve outcome and quality of life for these patients. In case of a solitary metastasis or a limited number of resectable metastases wide resections have to be considered according to patient profile, comorbidities, localization,

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... iness of the surgery and to benefit –risk balance. However such surgeries are highly demanding procedures that must be carefully planned and discussed in multidisciplinary team and with patient. Thus, surgical decision-making for a second metastasis and according to what criteria remains a subject of controversy. We report a case of an aggressive metastatic renal cell carcinoma with good functional and oncologic outcomes 3 years after surgery coupled with anti-angiogenic treatment. A review of the literature concerning recent attitudes in the management of bony metastatic renal carcinoma was carried out. Keywords: renal cell carcinoma; bone metastases; surgery; targeted therapy.