INTRODUCTION: We aimed to estimate the effectiveness and safety of neoadjuvant systemic therapy in locally advanced renal tumor patients who undergo a nephrectomy in terms of survival, tumor response, and surgical feasibility. METHODS: We included clinical trials, quasi-experimental studies, and cohort studies providing data on the use of neoadjuvant systemic therapy in managing locally advanced renal cancer before surgery in adult patients. The primary outcomes were cancer-specific survival (CSS), overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS). We performed a meta-analysis of proportions in R and assessed the risk of bias with the MINORS tool. RESULTS: Nine studies were included for qualitative synthesis and seven for meta-analysis. All non-randomized studies assessed had a low risk of bias against the stated objective by clearly stating their purpose. Likewise, most studies had a low risk of bias in the consecutive inclusion of patients, contemporary groups, and equivalence. Change in tumor size ranged from -50% to +7.9%. Partial response was achieved in 26% (95% confidence interval 15-42). CONCLUSIONS: Neoadjuvant therapy in locally advanced renal tumors ≥T3 or N1 has shown positive results regarding clinical tumor regression in about one-third of the patients. It is feasible and safe in this high-risk population.