Objective To explore the method of surgical treatment of complicated and severe vena cava malignant tumor and its effect. METHODS From December 2004 to July 2008, there were 5 male and 4 female cases, aged 37-69 years, mean 53.2 years. Seven patients had eight surgical resections of inferior vena cava tumors or/and tumors extending into the right atrium/interventricle under extracorporeal circulation or right atrial cannula perfusion, one case of inferior vena cava smooth muscle sarcoma had local recurrence of inferior vena cava artificial vascularization, and one case of superior vena cava tumor extending into the right and left innominate veins underwent reconstruction of the superior vena cava. There were 3 cases of artificial blood vessel replacement and 2 cases of inferior vena cava patch. Distant metastasis was excluded in preoperative CT or MRI examinations. Results Except for one case who died of liver failure 2 months after surgery, the other 8 patients were discharged from the hospital with symptomatic relief after surgery. The discharged patients were followed up for 5-45 months, with a mean of 16 months. Three of them had good results without recurrence at 14-24 months after surgery, one died of liver failure 5 months after surgery, four had in situ recurrence and multiple metastases 5, 4, 11 and 32 months after surgery, one of them had a rare polypoidal malignant fibrous histiocytoma of the inferior vena cava, which recurred and metastasized to the right adrenal gland 5 months later, and the inferior vena cava and right atrium/interventricular tumor were resected again 9 months later, which recurred and died of cardiac failure at 2 months after surgery. He died of heart failure after 2 months of recurrence. The other 3 recurrences were not operated again, among which 1 case was relieved after chemotherapy at 7 months after operation; 1 case of superior vena cava tumor was found to have brain metastasis at 11 months and died at 15 months; 1 case was lost at 45 months. Conclusion With adequate preoperative preparation and multidisciplinary cooperation, active surgical treatment of complex vena cava malignant tumors without metastasis from other sites can still significantly improve the quality of patients’ recent survival. Li Zhen, Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China