China is a large country with the largest number of liver cancer patients in the world, and surgical resection of liver cancer lesions is the only radical treatment. In recent years, with the continuous progress of technology, the new multidisciplinary collaborative treatment (MDT) based on surgical treatment has become a new model of liver cancer treatment and has effectively improved the survival of patients. The following shares the treatment of an extraordinarily large liver cancer patient. Patient Wang Moumou, male, 38 years old, felt distension in the liver area, poor appetite, abdominal distension and nausea in early February 2013, and visited a local hospital, where a CT examination was performed, which showed that “the left and middle lobes of the liver were huge occupants with a diameter of about 20 cm, and liver cancer was highly suspected”. The tumor was as high as 230.10U/ml, and the specific test for liver cancer, alpha-fetoprotein AFP, was higher than 10,000ng/ml, far exceeding the normal high value of 20ng/ml. The main difficulties for this extremely high-risk and complicated patient with huge liver cancer were: a. The tumor was huge and located in the middle part of the liver. CT showed that the tumor was about 20 cm in diameter, which was equivalent to the size of a small soccer, such a huge tumor is rare in clinical work. The tumor was located at the junction of the left and right liver, posterior to the middle hepatic vein, and was surrounded by layers of major vessels such as left hepatic vein, right hepatic vein, left and right portal vein trunk, inferior vena cava, left and right hepatic arteries and left and right hepatic ducts, and the tumor had invaded the left hepatic vein and middle hepatic vein. In order to achieve radical resection, all large blood vessels must be stripped off, just like digging out a huge mine in the grass, which will cause irreversible hemorrhage if not careful, and requires high skill of surgeon. The patient was only 38 years old, in the prime of life, with high metabolism, relatively high malignancy and fast growth of tumor, and high possibility of metastasis and recurrence after surgery. Since the tumor had invaded blood vessels and the BCLC tumor stage reached stage C, the risk of recurrence and metastasis after surgery was still high even if radical surgical resection was performed. Based on the long-term research of the physician team in the basic field of liver cancer, we decided to combine molecular targeted therapy with radical surgical resection to reduce the recurrence and metastasis of the tumor. Third, the tumor volume is very large, and due to the related anatomical conditions and the large blood vessels involved, the radical extensive resection, then the volume of the liver removed may have to exceed 60%, and the remaining less than about 40% of the volume of the liver, under the premise of already combined hepatitis B virus infection and impaired liver function, it is a challenge to retain enough normal liver tissue, and if the remaining liver function cannot be compensated, the patient may develop liver failure after the operation. If the remaining liver function cannot be compensated, the patient may develop liver failure after surgery. Therefore, it is important to preserve the maximum amount of normal liver tissue and to complete radical resection according to the anatomical conditions and the large blood vessels involved. With the help of computer-aided imaging three-dimensional reconstruction (IQQA) technology, we precisely assessed the patient’s tumor location, volume, surrounding vascular alignment and remaining liver volume before surgery, and virtualized the surgical section to obtain the best resection path and resection extent, so that we could effectively avoid intraoperative damage to the vascular structures and insufficient volume of the remaining liver after surgery. Finally, under the guidance of precision hepatobiliary and pancreatic surgery and multidisciplinary comprehensive diagnosis and treatment concept, we formulated a complete and detailed treatment plan: including the regulation of the preoperative systemic status, coagulation, liver function and other important indicators; the surgical access, resection steps, treatment of large vessels and biliary system during surgery; the application of rapid rehabilitation measures after surgery, psychological counseling and other treatment measures. After repeatedly communicating with the family about the surgical risks, surgical methods and post-operative adjuvant treatment plans, the decision was made to perform surgical resection treatment for extra-large hepatocellular carcinoma. On March 2, 2013, the General Hospital performed the surgery for resection of very large hepatocellular carcinoma. During the operation, we explored the huge tumor of segment IV and part of segment V of the liver, which was about 20*25 cm, hard and fixed, and pushed down the stomach and duodenum and pushed back the hepatoduodenal ligament to the right. After gradually separating and opening the sickle ligament and the left triangular ligament, we split the liver along the median fissure of the liver up to the level of the first hepatic hilar and saw that the tumor was located between the middle hepatic vein and the left hepatic vein and invaded the surrounding vessels, we carefully separated the tumor along the middle hepatic vein and performed an enlarged left hemicolectomy. We carefully isolated the main trunk of portal vein, left branch and root of left hepatic artery, cut and double ligated them respectively. The left hand held up the liver to protect the inferior vena cava and resected segment V and left half of the liver about 1,5 cm from the edge of the tumor in segment V. Part of segment IVa was preserved and the residual surface of the liver was hemostatic by electrocoagulation and the vessels and bile duct branches were sutured. We successfully resected the huge tumor radically and completed the hemostasis of the residual surface of the liver. Since all large blood vessels were protected as much as possible during the operation, the invaded large blood vessels were resected and reconstructed, and the normal liver tissues were preserved to the maximum extent possible, laying the foundation for postoperative recovery, and only 400 ml of blood was transfused during the operation. Under the guidance of the concept of rapid rehabilitation surgery, we actively regulated the patient’s general condition, actively encouraged the patient to get out of bed early and provided early nutritional support. early out of bed activities and early nutritional support. The patient recovered and was discharged 15 days after the operation without any complications such as fever, infection and bile leakage after such a huge hepatocellular carcinoma resection. Considering that the huge cancer had invaded the large blood vessels and the tumor stage was already stage C, the latest type of molecular targeted therapy: sorafenib was added to the follow-up treatment according to the expert consensus on liver cancer diagnosis and treatment issued by the Ministry of Health and the US NCCN guidelines, combined with the relevant laboratory research results. Sorafenib is the only drug recommended by the US NCCN guidelines for the prevention of tumor recurrence and metastasis after resection of the primary lesion of hepatocellular carcinoma. It can not only block tumor growth-related signaling pathways to inhibit tumor growth directly, but also block the formation of tumor neovascularization to indirectly inhibit tumor growth. It has been confirmed by large-scale multicenter randomized controlled trials in Europe and the United States that it can effectively prolong the survival of patients. The patient recovered very well after the operation. in March 2015, the 2nd anniversary of the operation, the patient came to the clinic again for follow-up, all the test indicators were normal, there was no sign of recurrence and metastasis, the patient was in good spirits and had a very high quality of life. This very large hepatocellular carcinoma in the middle liver lobe, due to the huge tumor and high malignancy, and had invaded large blood vessels and formed portal vein cancer thrombosis. Traditional radical resection of liver cancer has high possibility of recurrence and metastasis after surgery. On the basis of radical resection, combined with molecular targeted therapy and rapid recovery nutritional support, this patient, who originally had less than three months to live, successfully survived for more than two years and obtained a very good quality of life.