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Objective: To investigate the indication and value of surgical treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods: The clinicopathologic and follow-up data of 335 patients with HCC and PVTT were retrospectively analyzed. Of the patients, 273 cases underwent surgical treatment that included anatomic or non-anatomic liver resection (HR) plus PVTT removal (HR group), and 62 cases were subjected to transcatheter arterial chemoembolization (TACE) treatment (TACE group). The post-treatment survival between the two groups of patients was compared. Results: The median survival time for HR group and TACE group was 4.46 and 5.65 months, respectively, which had no significant difference (P=0.455); the 6- and 12-month survival rate for HR group was 30.7% and 12.1%, for TACE group was 38.7% and 19.2% respectively, which also showed no significant difference (both P>0.05). Conclusion: Concomitant PVTT in HCC is not a surgical contraindication, for which HR is safe and feasible, but offers no obvious survival advantage, so the option of surgical treatment should be considered cautiously according to the individualized assessments. The overall therapeutic effectiveness on this condition can be improved by the development of multi-disciplinary team (MDT) and precise medicine model in HCC treatment.