Background: Sarcopenia has recently been identified as a prognostic factor for various types of cancers. Our aim in this study was to investigate the relationship between sarcopenia and the clinical course and overall survival of patients with renal cell carcinoma (RCC) after surgical treatment. Methods: A retrospective analysis of the patients who underwent surgical treatment for RCC at our hospital, between 2008 and 2011, was conducted. Muscle mass was estimated by the cross-sectional area of the psoas major muscles at the level of L3, measured from computed tomography images. The area was normalized to height for between-comparison of the total psoas area (TPA, cm2/ m2). The median pre- and postoperative TPA was used as a cut-off to classify patients into high and low TPA groups. Overall survival, clinical and pathological factors were compared between high and low TPA groups. Results: The study group included 108 patients (83 males and 25 females). The median pre- and postoperative TPAs were 4.85 cm2/ m2 and 5.03 cm2/m2, respectively. Overall survival was longer among patients in the high than low TPA group (P=0.03), with sarcopenia being predictive of survival in males (P=0.004), but not in females. The pre- to postoperative change in TPA was predictive of postoperative adverse events, but not of surgical factors. Conclusions: A higher TPA is associated with longer overall survival after RCC surgery, particularly in males. The change in TPA after surgery was also predictive of postoperative adverse events, but did not influence operative factors.