Liver cancer with portal vein tumor thrombosis (PVTT) is a significant adverse prognostic factor for patients with liver cancer. However, the incidence of PVTT is 12.5–39.7% in patients with liver cancer, up to 64.7% in autopsied patients with liver cancer, up to 90% in patients with advanced liver cancer, and 20–30% in patients with small liver cancer. The median survival time of patients with liver cancer complicated with PVTT in the natural course of the disease is 2.7–4.0 months, whereas that of patients with liver cancer without PVTT is 24.4 months. According to the Barcelona Clinic Liver Cancer (BCLC) staging system widely applied internationally, liver cancer with PVTT is classified as BCLC stage C. At present, there is no unified international standard for the treatment of liver cancer with PVTT, and the American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) recommend molecular targeted therapy (sorafenib/lenvatinib) as the only first-line treatment regimen, based on the BCLC staging system. The Hong Kong Liver Cancer Staging System recommends TACE as the first-line therapy for liver cancer with PVTT, but for tumors smaller than 5 cm in diameter with Child-Pugh class A liver function and intrahepatic vascular invasion, surgical resection is recommended. The Japan Society of Hepatology and the Asian Pacific Association for the Study of the Liver both recommend surgical resection as an option of the multiple treatment strategies for liver cancer with PVTT.