Background: The safety and efficacy of upfront VEGF targeted, before nephrectomy in metastatic clear cell renal cancer (mCCRC) has not been robustly evaluated. Methods: In this study we performed a meta-analysis of 3 studies (NCT) with an almost identical design and included a single institution experience (which adopted this approach as a standard). Patients with newly diagnosed mCCRC had 12-18 weeks of sunitinib or pazopanib therapy prior to planned cytoreductive nephrectomy (CN). Results: 224 patients were included in this analysis (54% had sunitinib and 46% pazopanib). Overall, 73% had MSKCC intermediate risk and 23% poor risk disease. 20% of patients had an ECOG performance status of 0.84% of patients obtained stable disease or a response to therapy (by RECIST) before surgery. The median reduction of size of the primary tumour was 14%. 60% of patients had CN. The commonest reason for not performing CN was progression of disease. Progression free survival (PFS) and overall survival (OS) was 6.2 (95% CI 5.7-6.7) and 13 (95% CI: 10.2-15.7) respectively. Patients with MSKCC poor risk disease had a poor outcome irrespective of CN (OS = 7.5 months 95% CI 5.8-9.2). A comparison of sunitinib and pazopanib showed no significant difference in median PFS 7.1 (95% CI, 6.0-9.2) and 6.0 (95% CI: 5.1-6.8) or surgical complications (p<0.05). Conclusions: Outcomes with this approach are in line with expected survival for this population. Results with sunitinib and pazopanib were similar. This approach is attractive for patients with MSKCC intermediate risk disease.