Oncologically unresectable tumors classi ed as a partial response (PR) or stable disease (SD) based on RECIST ver1.1 or mRECIST that were maintained for at least 8 weeks or technically unresectable tumors that became resectable due to the response to lenvatinib treatment were considered amenable to curative resection, and the patient was considered a candidate for surgical intervention with a few exceptions. If patients had manageable extrahepatic metastases, noncurative surgery leaving the extrahepatic metastases in situ was performed if surgery was considered to contribute to prolonged survival or lenvatinib therapy could not be continued due to adverse effects. The indication for surgery was nally determined at the multidisciplinary tumor board conference based on tumor location, distribution, and response to lenvatinib. Ablation therapy for intrahepatic tumors and pulmonary metastases was also utilized if indicated. Major hepatectomy was de ned as resection of four or more liver segments.