Two patients with renal cell carcinoma invading the inferior vena cava to the level of the right atrium underwent complete excision of their renal tumours. Clearance of the caval extension was accomplished using cardiopulmonary bypass, profound hypothermia and circulatory arrest. The use of these techniques visually improved the operative field without extending operating time. Profound hypothermia and circulatory arrest do not increase postoperative morbidity or mortality and offer the best opportunity for cure
