New antiangiogenic molecules have proven an advantage in term of survival in metastatic renal cell carcinoma. We describe herein two clinical cases showing the efficacy of antiangiogenic agent in locally advanced or metastatic renal cell carcinoma. In this cases the surgical management has been altered in front of an important tumor necrosis provided by this treatment. The role of antiangiogenic agents as adjuvant or neo adjuvant therapy has not yet been defined precisely. However, these new molecules open new perspectives in the therapeutic field of metastatic renal cell carcinoma notably in case of bulky tumors which appeared difficult to remove surgically at first look or in case of early recurrence after radical nephrectomy.