Lecture : According to the AASLD/BCLC staging system and treatment guideline, portal/hepatic vein tumor thrombosis (PVTT/HVTT) in hepatocellular carcinoma (HCC) is regarded as advanced stage of the disease and is associated with extremely poor prognosis. Treatment strategy for this is limited. Hepatic resection is optimistic for early staged PVTT, otherwise systemic therapy with tyrosin kinase inhibitors and TACE or radioembolization is recommended, however those remedy has shown limited survival benefit. Hepatic surgeons, mostly East Asian surgeons, have tried surgical resection for the advanced PVTT in selected patients, and reported survival gain in early stage PVTT (stage 1 & 2). In accordance with recent advancement of surgical technique, experienced surgeons underwent surgical resection for the advanced HCC with HVTT as well as PVTT, and has shown pretty good long-term survivals. Several well designed studies have shown survival benefit by surgical resection obtained in only stage I-PVTT. Although hepatic resection with removal of advanced portal vein tumor thrombosis is successful, there has been little survival benefit for stage 3 and 4 in comparison to other non-invasive therapy like TACE or target therapy. Some expert surgeons often have reported together with video presentation and a tale of heroism about successful surgical resection for the patient who have HCC in the HV trunk or right atrium. Surgical outcome may be successful but has shown early recurrence or metastasis. Therefore, in surgical resection for the advanced HCC with PVTT/HVTT, surgeons should be careful in selection, hopefully for early staged tumor thrombus. Regarding surgical technique, limited hepatic mobilization before hepatic transection with application of hanging maneuver or total hepatic vascular exclusion is recommended. For removal of the thrombus, complete occlusion of blood flow to prevent drop-off the thrombus until complete removal of it is also necessary.