Today, in spite of the advanced diagnostic methods, the frequency of renal tumors increases. For the patients with renal tumor with or without vena cava involvement, the curative treatment is surgery. Tumors with renal vein and/or vena cava involvement that are accepted to be stage T3b and T3c have particular importance. The recently accepted view in the management of these tumors with a thrombus in atrial area and/or in supradiaphragmatic vena cava is hypothermia with cardiac by-pass or veno-venous by-pass with radical nephrectomy and thrombectomy. Thrombectomy and radical nephrectomy without these methods should be performed in the patients with infradiaphragmatic thrombus. Laparascopic approach which has been recently standardized on the treatment of renal tumors can be mostly performed in the existence of thrombus in renal vein. The surgery of stage T3b and T3c should be performed in multidisciplinary fashion in the existence of sufficient equipment and experienced personnel.