Hepatocellular carcinoma (HCC) with extension of its tumor thrombus into the inferior vena cava (IVC) and right atrium has been regarded as beyond the realm of surgical resection. It could cause sudden death due to pulmonary embolism or heart failure by the detached fragments of tumor thrombus. In recent years, successful surgery has been reported for hepatic malignancies with its tumor thrombus to the IVC and right atrium by some centers of Taiwan and Japan. We also did a successful en bloc resection of the liver tumor and its tumor thrombus in the IVC and right atrium using cardiopulmonary bypass and report herein.