We report a long-term survival case of hepatocellular carcinoma with lymph node metastases treated with surgery and radiotherapy. A 71-year-old man was admitted to our department at Kumamoto University Hospital in May 2003 for a treatment of local recurrent HCC after transarterial chemoembolization. CT showed an infiltrative type tumor, 2.5 cm in diameter, in the segment 8 of the liver. We treated the liver tumor with a right paramedian sectionectomy in May 2003. Postoperatively, lymph node metastases and recurrent HCC were diagnosed. Three times of local ablation therapies for recurrent HCC, twice lymph node dissections, and twice radiotherapies for lymph node metastases were successfully achieved. The patient survived without recurrence for 60 months after the initial hepatectomy.