Inclusion Criteria:

        Diagnosis of HCC A) 1st diagnosis of HCC - no prior treatments of HCC B) Diagnosis made by
        contrast enhanced CT or MRI with arterial and portal phases

          1. Arterial enhancement

          2. Venous washout

          3. Expanding/enhancing tumor thrombus seen in portal vein Extent of HCC spread A) Vp1-3
             (Japanese system) - VP1-2 (Cheng criteria - Shanghai) B) No involvement of main portal
             vein Vp4 (Japanese system) - Vp3 Shanghai C) No evidence of extra-hepatic spread in
             abdomen D) No evidence of hepatic vein or vena cava invasion Need for Biopsy A)
             Patients not meeting above criteria B) Absence of underlying liver disease
             Demographics A) Age ≥ 18 Women of reproductive age A) Negative pregnancy test B) Must
             be on birth control for duration of study Able to provide informed consent No prior
             malignancy A) Excluding basal/squamous cell skin cancers B) Excluding superficial
             bladder cancer C) Excluding cervical cancer Underlying liver disease A) HBV, HCV,
             alcohol, or none B) All HBV patients must be placed on anti-viral therapy prior to any
             treatment and continue through entire study C) Co-infection HBV with HCV excluded D)
             HIV infection excluded Liver function/Performance status A) Child's A or B7 liver
             function B) Absence of clinical portal hypertension

        a. Platelet count ≥ 100,000 b. No evidence of varices or splenomegaly on imaging c. No
        ascites ECOG performance status 0-1 Tumor characteristics A) Size of largest tumor ≤ 10cm
        B) <50% of liver volume involved by tumor C) Multiple tumors allowed D) All tumors all
        confined to same lobe as PV involvement E) Hepatic Vein or Inferior Vena Cava involvement
        excluded Non-contrast CT of chest A) No lung metastases B) Involvement of gallbladder and
        diaphragm allowed C) Involvement of omentum allowed D) Involvement of abdominal wall
        allowed E) Involvement of colon, stomach, duodenum excluded

        Exclusion Criteria:

        Unable to provide informed consent Age <18 years Unable to take anti-viral medication for
        hepatitis B Unable to take sorafenib Medically unfit for surgery Prior malignancy other
        than those specifically allowed by study Prior treatment of HCC Tumor characteristics A)
        HCC >10cm B) Bilobar tumor C) Mixed cholangiocarcinoma HCC D) Extra-hepatic tumor E) Tumor
        involving stomach, duodenum or colon F) Tumor involving hepatic veins or vena cava G) Tumor
        involving portal vein bifurcation

        Liver disease A) Liver function decompensated beyond Child's B7 B) Significant portal
        hypertension - splenomegaly, varices, ascites or platelet count <100,000 C) Co-infection
        with HBV and HCV D) Co-infection with HIV ECOG performance status >1