Objective: To investigate the clinical efficacy of hepatic lobectomy with transhepatic resection of cancer embolus in the treatment of primary hepatocellular carcinoma combined with portal vein thrombosis. Methods: Sixty patients with primary hepatocellular carcinoma combined with portal vein thrombosis underwent lobectomy or hepatic resection and removal of cancer embolus, and the surgical efficacy was compared with that of patients with hepatocellular carcinoma without cancer embolus during the same period. The survival rates at 6 and 12 months were 88.3% and 51.7% in the portal vein embolism group, respectively, compared with 93.3% and 62.2% in the hepatectomy group alone, which were not significantly different (P>0.05). Conclusion: Surgical resection of primary hepatocellular carcinoma combined with portal vein thrombosis and removal of the thrombus from the portal vein of the liver section did not increase the trauma and difficulty of surgery, and its therapeutic effect was similar to that of surgery for hepatocellular carcinoma without thrombosis.