Background: Evidence from U.S. national databases suggests that racial-ethnic underrepresented groups are less likely to receive surgical treatment for renal cell cancer and experience worse survival compared to non-Hispanic White patients. Access to medical care has been implicated in these disparities. We aimed to study surgery receipt and overall survival of renal cell cancer in the equal access Military Health System (MHS) to better understand these disparities. Materials and Methods: We used the Military Cancer Epidemiology (MilCanEpi) database to study a cohort of patients aged 18 and older who were diagnosed with stage I-III renal cell carcinoma (RCC) belonging to clear cell, papillary, chromophobe, or unclassified histologic subtypes between 1998 and 2014. Treatment with nephrectomy, cancer recurrence, and all-cause death were assessed and compared between racial-ethnic groups. The likelihood of nephrectomy was evaluated in logistic regression models expressed as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Risk of all-cause death was estimated using multivariable Cox regression models and expressed as adjusted hazard ratios (AHRs) and 95% CIs. Results: The study included 1,371 non-Hispanic White, 362 non-Hispanic Black, and 177 Hispanic patients with RCC. Overall, Black patients tended to be less likely to receive nephrectomy as non-Hispanic White patients (AOR=0.69, 95% CI=0.47, 1.00). The association was statistically significant among patients with stage I (AOR=0.62, 95% CI=0.41, 0.95) or clear cell RCC subtype (AOR=0.46, 95% CI=0.22, 0.96) in stratified analysis. Hispanic patients were as likely to receive nephrectomy as non-Hispanic White patients overall (AOR=1.35, 95% CI=0.73, 2.49) and there were no significant differences in strata by stage or histologic subtype. Regrading outcomes, there were no overall statistically significant differences in recurrence for Black (AHR=0.69, 95% CI=0.45, 1.04) or Hispanic (AHR=1.02, 95% CI=0.66, 1.57) patients or in all-cause death for Black (AHR=0.90, 95% CI=0.57, 1.44) or Hispanic (AHR=0.51, 95% CI=0.25, 1.04) patients compared to the risks for non-Hispanic White patients in multivariable models. Conclusion: The findings in the equal access MHS that Black patients with stage I or clear cell tumors were significantly less likely to receive nephrectomy than their non-Hispanic White counterparts suggest factors other than access to care in racial disparities in surgical management of non-metastatic RCC for this stage and histologic type. However, there were no overall racial differences in recurrence or survival overall for Black compared to non-Hispanic White patients when adjusted for surgery received and other potential confounders. Among Hispanic patients, there were no differences in the receipt of nephrectomy or in clinical outcomes compared to non-Hispanic White patients. As the management of renal cell cancers shifts toward more conservative surgical approaches and increased use of adjuvant radiation or chemotherapy, more research in equal access health systems is needed to determine whether racial or ethnic disparities in treatment persist, what factors may play a role in treatment differences, and what the impact on survival may be.