Among hepatocellular carcinoma patients, there is a distinct high-risk population for primary surveillance. Patients who underwent curative resection have a 5-year recurrence rate of as high as 70% and they are also considered to be at high risk. Based on currently available evidence, the recommended postoperative surveillance protocol is: monthly or bimonthly measurement of two tumor markers including alpha-fetoprotein and PIVKA-II, ultrasonography every 2 to 3 months, and enhanced CT every 6 months. This protocol may be too intense, but it is often requested by patients who have been informed about the nature of the disease and the high risk of recurrence. This intense protocol may detect tumor recurrence earlier and may provide a better chance for curative treatment. However, there is no sufficient evidence showing that this protocol confers survival benefit.