Renal cell carcinomas have a tendency to extend along the renal vein, and even the inferior vena cava. In patients who have renal vein or vena cava extension without extension outside the renal parenchyma and without nodal or distant metastases, the survival at five years is 50%. With presence of lymph node involvement, the survival markedly decreases; but long-term survivals have been reported in up to 20% of cases when the tumor can be completely resected. A 45 year old woman presented with a large tumor mass of the right kidney with tumor extending into the inferior vena cava and involvement of retroperitoneal lymph nodes without distant metastases. This video depicts a radical nephrectomy and partial resection of inferior vena cava with extraction of inferior vena cava tumor thrombus.