The treatment of renal cell carcinoma (RCC) with cavoatrial involvement represents a major surgical challenge. To date, many surgical strategies have been proposed. However, general agreement on the best approach does not yet exist. Deep hypothermic circulatory arrest (DHCA) is the most commonly used method and allows complete tumor resection without increasing operative risk. Cardiopulmonary bypass (CPB) without circulatory arrest and methods using no CBP were also proposed, without a clear evidence of superiority of 1 technique over the others. Further studies are needed to evaluate the possible role of alternative techniques compared with deep hypothermic circulatory arrest.
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