In parallel with advances in the treatment of metastatic renal cell carcinoma (RCC), multiple adjuvant treatments have been tested for RCC. Adjuvant approaches now extend beyond conventional immunotherapies, such as interferon alfa and interleukins, to targeted therapies and immune checkpoint inhibitors. Most treatment approaches before the targeted treatment era did not improve patient outcomes, or study results were mixed. For example, a recent study found that disease-free survival was longer with sunitinib than with placebo in high-risk clear cell RCC, which led to the regulatory approval of sunitinib. However, another large study of adjuvant sunitinib in a slightly different patient population did not confirm these results. Ongoing studies of targeted treatments and immune checkpoint inhibitors may clarify the effectiveness of these agents in the near future. This review presents a comprehensive, chronologic examination of studies addressing adjuvant treatment in RCC, focusing on the key differences between similar approaches. It also discusses the future of adjuvant treatment in RCC.