A lady was diagnosed of tumor mass on the right adrenal gland involving right kidney and surrounding lymphophatty tissue (22 centimeters diameter). Large thrombus in the retrohepatic vena cava extended to the atrium and occupating 2/3 of the cavity of the auricula was shown. The patient was referred to us because was considered unresectable. Evaluation by TAC and MRI was done and the surgical treatment was considered in two steps. First step: By extracorporeal circulation, the atrium was opened and thrombus of the auricula and vena cava was removed. The atrium was closed and extracorporeal circulation finished. Second step: Three weeks later, right subcostal incision was performed. The big tumoral mass was identified and mobilized, right ureter was ligated and severed. Vena cava dissected and the retrohepatic segment preserved. Right renal vein and the artery were closed and divided using stapler (TA 30/3.5). The mobilization of the tumour include a big surface of the diaphragm. The tumour with sufficient free margin was removed. The operation finished with the closure of the diaphragm and abdominal wall. MRI showed its normal aspect. Comments of the follow-up are included