Renal cell carcinoma (RCC) is often complicated by invasion of renal vein and inferior vena cava, as well as pulmonary embolism in some cases. The authors report successful surgical treatment of a patient with RCC and free-floating tumor thrombus in inferior vena cava complicated by massive embolism of the right pulmonary artery. Simultaneous two-stage surgery was performed. At the first stage, right heart surgery under cardiopulmonary bypass and cold blood cardioplegia with embolectomy from pulmonary artery and its branches was performed via median sternotomy. Abdominal stage included right-sided nephrectomy and adrenalectomy, removal of thrombus from suprarenal and retrohepatic segments of IVC with suprarenal IVC resection and paracaval lymph node dissection. Postoperative period was uneventful with fast regression of destructive pneumonia of the upper right lobe. This surgical strategy can be considered in patients with malignant IVC obstruction and pulmonary embolism.