Lecture : Huge HCC, which is generally defined when its greatest diameter is 10 cm or more, although there is a variation according to literatures, has a poorer prognosis than that of smaller HCC due to higher incidence of vascular invasion and more aggressive tumor biology. Unfortunately, patients with huge HCC are not eligible for other treatment modalities such as liver transplantation, percutaneous ethanol injection therapy (PEIT), radiofrequency ablation (RFA), and while some centers tries transarterial embolization (TAE), the 5-year survival rate is less than 10%. Consequently, surgical resection remains the only treatment option that offers opportunities for long-term survival or complete cure. However, surgical resection of huge HCCs is a great challenge to the liver surgeons, because surgery for these tumors entails prolonged operative time and has an increased risk for massive bleeding or liver failure after major hepatectomies in patients with chronic hepatitis or early stage cirrhosis; furthermore, rapid recurrence after surgery is not infrequent. Here, I describe the surgical technique of right hepatectomy for huge HCC. 44-year-old male patient who had huge HCC-CCC (20*16.5*10 cm) and HBV was admitted to AMC for surgery. There were no extrahepatic metastases in chest CT, bone scan, and whole body PET. The laboratory findings were as follows ; CBC 9700-15.9-44.2%-423k, PT 87.5%, SGOT/SGPT 98/18, TB 1.2, P/ALB 9.4/3.6, AFP 5770 ng/ml, PIVKA II 9380 mAU/ml, and ICGR15 23.7%. The inverted-T incision with partial sternotomy was used and the hepatic parenchyma were transected with fully exposure of MHV using a CUSA. The important thing of this surgery was to maintain a wide operative field and use the anterior approach during hepatectomy. The right glissonean pedicle was identified, taped, and ligated before the mobilization of the right liver. The Pringle maneuver was carried out as usual (15 mins for occlusion and 5 mins for reperfusion). The operativee time was 540 mins and estimated blood loss was less than 1000 ml. The patient was discharged on postoperative day 23. References. 1. Jo SH. Outcome of hepatectomy for huge hepatocellular carcinoma. Korea. Ann HBP Surg 2011; 15: 90-100 2. Kim KH, Lee SG. Usefulness of Kelly clamp crushing technique during hepatic resection. HPB 2008; 10: 281-284.