The authors present a 75-year-old patient with renal cell carcinoma and subdiaphragmatic inferior vena cava thrombosis. Renal cell carcinoma stage III T3bN1M0, inferior vena cava thrombosis, anemia, severe intoxication syndrome, coronary artery disease, multivessel atherosclerotic lesion of coronary arteries, angina pectoris class 2, paroxysmal atrial fibrillation, chronic heart failure NYHA class IIa and post-inflammatory lung lesion after previous viral pneumonia were diagnosed at admission. A council included urologist, oncologist, cardiac surgeon, endovascular surgeon, cardiologist, anesthesiologist and specialists for X-ray diagnosis. Stage-by-stage surgical treatment was preferred with off-pump internal mammary artery grafting at the first stage and right-sided nephrectomy with thrombectomy from inferior vena cava at the second stage. Nephrectomy with thrombectomy from inferior vena cava is the «gold standard» for patients with renal cell carcinoma and inferior vena cava thrombosis. This highly traumatic surgery requires not only accurate surgical technique, but also specific approach to perioperative examination and therapy. Treatment of such patients is recommended to be carried out in a highly specialized multi-field hospital. Teamwork and surgical experience are very important. Team of specialists (oncologists, surgeons, cardiac surgeons, urologists, vascular surgeons, anesthesiologists, transfusiologists, diagnostic specialists) harmonizing a single management strategy at all stages of treatment increases effectiveness of treatment.