In China, more than 85% of primary hepatocellular carcinoma (hereafter referred to as hepatocellular carcinoma) is closely related to hepatitis B virus infection. Liver inflammation is the causative factor for the development of liver cancer. Under the guidance of Academician Wu Mengchao, the medical staff of the Department of Hepatology and Surgery of Shanghai Oriental Hepatobiliary Surgery Hospital confirmed through a large-scale clinical trial that postoperative antiviral therapy for hepatocellular carcinoma can bring significant survival benefits to patients with hepatocellular carcinoma. The results showed that the 4-year recurrence rate of hepatocellular carcinoma patients without antiviral drugs was as high as 87.9% after surgery, while the 4-year recurrence rate decreased to 62.7% after antiviral drugs were administered. The 4-year overall survival rate of the antiviral treatment group was 86.4%, which was also significantly higher than that of the control group (47.4%). The results have been published in leading international oncology journals (Journal of Clinic Oncology, impact factor 18.3 and Ann Surg Oncol, impact factor 4.5). Our study confirms with a high level of evidence-based medical evidence that antiviral therapy improves the prognosis of hepatocellular carcinoma and has begun to be disseminated in clinical practice. However, the majority of hepatitis and liver cancer patients are not yet aware of these recent advances, so we discuss this issue in the context of a case we recently treated. Mr. Luo from Zhejiang province, who had a history of hepatitis B “small triple positive”, was recently diagnosed with hepatocellular carcinoma and underwent surgery at Shanghai Oriental Hepatobiliary Surgery Hospital, which was successful and his postoperative recovery went well. However, three months after his discharge from the hospital, Mr. Luo gradually felt that his mental state and appetite had deteriorated, and he was weak, and what’s more, his skin and sclera gradually turned yellow. He rushed back to the hospital for a review, and we found that although Mr. Luo was a “minor triple-positive” hepatitis B, his hepatitis B viral DNA load reached 10,000 copies/mL, and he was considered to be in acute hepatitis B attack. After further questioning about his medical history, it turned out that Mr. Luo’s health condition gradually improved after he was discharged from the hospital, and he slowly relaxed his vigilance. After understanding this situation, we suggested that he immediately restart the antiviral drug entecavir. After a period of treatment, Mr. Luo’s symptoms improved significantly, the jaundice subsided, and his spirit and appetite improved. Blood tests showed that the hepatitis B viral DNA load dropped to less than 500 copies/mL, and transaminase levels and indicators such as bilirubin and albumin returned to normal. Mr. Luo was puzzled: although he had a history of hepatitis B “small triplet” for more than 10 years and had heard his doctor say his “hepatitis B viral DNA load” was relatively high before the operation, he had never had any special symptoms, and the local doctor had told him that it did not matter. The local doctor also told him that he did not need any special treatment for “small triple positive” and that he should just observe. However, why did he have an acute attack of hepatitis after liver cancer surgery? Will such a violent hepatitis attack have a bad effect on the efficacy of liver cancer surgery? In the future, should we take antiviral drugs for a long time and how can we stop them? Will such medication increase the burden on liver and kidney? This series of questions made Mr. Luo lose his appetite and feel anxious. We believe that many liver cancer patients like Mr. Luo, and even some doctors in primary hospitals, believe that hepatitis B “small triple-positive” or “carriers” do not need treatment. The fact is that patients with previous hepatitis B virus infection, especially with high viral load, even without clinical manifestations of hepatitis, can continue to cause inflammatory damage to the liver, significantly increasing the risk of liver cancer. Especially after liver cancer resection surgery, general anesthesia and radiotherapy, the hepatitis B virus is easily “activated”. Some patients who did not have clinical manifestations of hepatitis B may suddenly develop various symptoms of hepatitis B. At the same time, this may lead to a higher recurrence rate of hepatocellular carcinoma after surgery, and in severe cases, it may even lead to acute severe hepatitis, which is directly fatal. The continuous activity of hepatitis B virus may also lead to the formation of portal vein cancer thrombosis in hepatocellular carcinoma, bringing the course of the disease to an advanced stage. Mr. Luo had a post-operative “reactivation” of the hepatitis B virus. For such a patient, the doctor was distressed that the surgery was a lost cause even if it was successful. It was a good thing that he returned to the hospital as soon as possible for a checkup so that we could give him a helping hand in time. For post-operative liver cancer patients, antiviral therapy can not only reduce the risk of virus reactivation, but also inhibit virus replication, reduce liver inflammation response, significantly reduce the possibility of normal liver cells becoming cancerous again, and thus reduce the risk of post-operative recurrence. After the liver inflammatory response is reduced, liver function can also be improved, helping patients tolerate other adjuvant treatments after surgery. It can be seen that regular and systematic antiviral treatment can effectively improve the prognosis of liver cancer patients for surgery and prolong their survival. Whether the hepatitis B virus is active or not, i.e. the level of hepatitis B viral DNA load is the most important factor in deciding how to administer antiviral therapy. For hepatocellular carcinoma patients with positive hepatitis B viral DNA load (>500 copies/mL), antiviral drugs must be started as early as possible and for a long time; while for patients with negative hepatitis B viral DNA load (<500 copies/mL), they should be closely followed up after surgery, and if the hepatitis B viral DNA load turns positive during the monitoring process, antiviral drugs should be used immediately. During the course of antiviral therapy, patients should never stop the medication at will or change the variety or dose of medication without medical advice, and any adjustment of medication should be made under the guidance of a physician. The treatment should be started with a single drug, and liver function and hepatitis B virus DNA load should be reviewed regularly. For patients who have been treated for more than 6 months without a significant decrease in viral DNA load, they are considered drug resistant and should be switched to a different drug or a combination of 2. Some patients worry that long-term antiviral drugs will aggravate liver and kidney damage. As liver cancer itself has less "liver" than others, will long-term medication have any effect? In fact, oral antiviral drugs commonly used in the market include lamivudine, entecavir, adefovir, timivudine, etc. Although all of them have potential hepatic and renal toxicity, the probability of these toxic side effects at safe doses is low, and only regular monitoring of liver and kidney functions is needed to adjust the drugs in time if there are abnormalities. For patients with renal insufficiency, you should consult your doctor to adjust the dosage according to the specific situation. As the saying goes, "a disease is as good as a disease". For every liver cancer patient, one should be a patient silk drawer and should never think that surgery can be "cut in one stroke". After surgery, patients should actively and patiently receive various adjuvant treatments, including antiviral therapy, in order to improve the prognosis and prolong the survival time to the greatest extent.