Abstract: Hepatocellular carcinoma with inferior vena cava tumor thrombus is the presentation of advanced liver can cer, and the efficacy of surgery was poor in the past. With the development of surgical techniques, surgical treatment could not only remove the primary tumor, but also prevent heart failure and pulmonary embolism caused by tumor thrombi. One patient with hepatocellular carcinoma with intrathoracic inferior vena cava tumor thrombus was admitted to the Fujian Provincial Hospital. The new approach to incise the diaphragm through the abdominal cavity and expose the intrathoracic inferior vena cava during the operation was investigated.