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Background: the neoadjuvant use of immune checkpoint inhibitors (ICIs) in patients with kidney cancer and bladder cancer is controversial, and there are reports suggesting increased difficulties in surgeries in these settings.

Aims: we performed a systematic review using PRISMA guidelines methodology to analyze pertinent literature available up to January 05, 2024 in PubMed, updating our previously published systematic review on the subject.

Results: we have selected 25 publications for the neoadjuvant use of different immune checkpoint inhibitors before nephrectomies for kidney cancer and seven publications concerning the neoadjuvant use of immune checkpoint inhibitors before cystectomies for bladder cancer. Reports of additional surgical difficulties were noted in 6/25 reports for kidney cancer and 0/7 reports for bladder cancer.

Conclusions: in the setting of neoadjuvant immune checkpoint inhibitors, a minority of cases of nephrectomies may be challenging due to inflammatory changes to the surrounding tissues, which may require more experienced surgeons. Neoadjuvant immune checkpoint inhibitors do not seem to pose additional surgical difficulties in cystectomies for the treatment of bladder cancer.