It is generally accepted that renal cell carcinoma (RCC) usually metastasizes to distant organs through blood circulation rather than lymphatogeneous dissemination. Clinical and autopsy studies have revealed that most lymph node (LN) metastases accompany distant metastasis. In addition, LN dissection (LND) can reveal a positive node in limited cases in which nodes negative preoperatively, suggesting that diagnostic significance of LND is low in such cases. Although the significance of LND in RCC remains controversial, it is also reported that RCC patients with regional LN metastasis alone had an improved survival after LND. Animal models have indicated that detection of sentinel nodes in RCC might facilitate a more personalized treatment of LND in RCC.