The management of renal cell carcinoma with suprahepatic intracaval neoplastic extension is described, including the utilization of cardiopulmonary bypass, hypothermia, and temporary cardiac arrest. The overall experience is presented and three patients are described in detail, including one patient with a right-sided tumor and the second with a left-sided tumor. The third patient has a massive right-sided tumor and intracaval thrombus with caval reconstruction by a pericardium patch.