Background <p>Renal cell carcinoma (RCC) has a high recurrence risk, with 20–40% of patients developing metastatic disease post-nephrectomy. This study aimed to identify risk factors associated with liver and pancreatic metastases in patients who have previously undergone curative nephrectomy for RCC.</p> Methods <p>This retrospective cohort study with a nested case-control design included adults who underwent nephrectomy for non-metastatic RCC (non-mRCC) between 2009 and 2021. Patients who developed liver or pancreatic metastases, confirmed by secondary surgery, formed the case group. A randomly selected control group of non-mRCC patients were included to assess risk factors. Clinical, radiological, and pathological data were analyzed.</p> Results <p>Among 967 nephrectomy patients, 754 (78%) had RCC, and 6% developed liver or pancreatic metastases. Advanced tumor stage (T3) was a significant predictor of RCC metastasis in these patients. Patients with a prolonged disease-free interval demonstrated better surgical eligibility and survival outcomes. Median time from nephrectomy to metastasis was 57 months in surgical cases compared to 22 months in non-surgical cases. Notably, 92% of patients eligible for metastasis surgery had clear cell RCC (ccRCC). Surgical resection was associated with improved survival, with 1-, 3-, and 5-year survival rates of 92%, 83%, and 75%, respectively, compared to 77%, 65%, and 56% for non-surgical patients.</p> Conclusions <p>Advanced tumor stage and local invasiveness were key predictors of liver and pancreatic metastases in RCC. Prolonged time to metastasis improved surgical eligibility and survival. The majority of patients eligible for metastasis surgery had ccRCC. Further studies are needed to evaluate whether early, individualized follow-up for high-risk RCC subtypes improved surgical eligibility for liver and pancreatic metastasis.</p>