Liver resection combined with systemic therapy offers better survival for patients with hepatocellular carcinoma and macrovascular invasion.

• Overall survival rates at 1, 3, and 5 years post-resection were 65.9%, 37.7%, and 28.6%, vastly superior to 29.3%, 10.1%, and 5.4% in non-resection groups.
• Preoperative systemic therapy led to even higher survival rates: 81.2%, 50.0%, and 40.6% at the same intervals.

Prioritizing liver resection with preoperative treatment could be key for this patient group.