Indefinite antiviral therapy may be required after surgical resection for hepatocellular carcinoma complicating chronic hepatitis B.

This report describes a 66-year-old male who had a long history of hepatitis B virus (HBV) infection. He was found hepatocellular carcinoma (HCC) 5 months after lamivudine resistance mutation and then received a successful hepatectomy. Three years later, hepatitis B envelope antigen seroconversion was achieved and nucleoside analogs were discontinued. After the withdrawn of antiviral treatment, HBV reactivated and acute-on-chronic liver failure (ACLF) occurred. Anti-HBV treatment improved the patient clinical condition. Three months after the remission of ACLF, the patient was diagnosed as HCC recurrence and received another hepatectomy. This case illustrates indefinite duration antiviral therapy and tight viral control should be performed in patients with HBV-related HCC.