Renal cell cancer with tumor thrombus is present in 4-15% of cases. The prognostic significance of this entity has been object of intense debate. Nowadays, it is considered, that the presence of thrombus itself does not have a negative prognostic impact on survival rates if the thrombus could be excised satisfactorily. Complete removal of renal malignant tissue is the only curative strategy for the treatment of this kind of tumors.During the last three decades, there has been steady im-provements in surgical technique and preoperative care fields that have favorably modified the surgeons’ ability to safely excise these tumors. In this sense, the experien-ce provided by multiorgan, kidney-pancreas and liver procurement and transplantation techniques led the uro-logists re-examine their approaches to the inferior vena cava and retroperitoneum, thus they could result useful in the always challenging resection of these complex tumors with neoplasic extension into the vena cava.