BACKGROUND: Renal tumors with inferior vena cava (IVC) invasion pose significant challenges for surgical and anesthetic management. This report presents the anesthetic management of a patient with a level 3 IVC-invading renal tumor, emphasizing the complexity and multidisciplinary approach required. CASE PRESENTATION: A 55-year-old woman with a large left renal tumor causing complete obstruction of the left renal vein and near-total obstruction of the IVC was admitted for surgery. Multidisciplinary planning included a nephrectomy with removal of tumor from the IVC. The patient underwent general anesthesia with extensive hemodynamic monitoring and fluid management to mitigate potential blood loss and cardiovascular instability. The surgery, lasting 5 h, involved successful radical nephrectomy, tumor removal from the IVC, and resection of liver metastases. Postoperative recovery was without complications, and the patient was discharged 7 days. CONCLUSION: Managing anesthesia for renal tumors with IVC invasion requires careful preoperative planning, invasive monitoring, and multidisciplinary approach.