For early-stage hepatocellular carcinoma (HCC) with limited tumor spread, practice guidelines recommend surgical therapies, i.e., resection and/or transplantation, which yield substantial survival benefit to the patients. Impaired liver function due to underlying chronic liver disease is a major limiting factor for hepatic resection. Several methods such as portal vein embolization and ALPPS procedure have been developed to increase hepatic functional reserve and expand applicability of resection. Recent advance in robotic engineering technology has allowed to develop minimally invasive laparoscopic resection tailored for each patient’s tumor characteristics. Adjuvant therapy to prevent postsurgical HCC recurrence is an unmet need. Precise prediction of individual recurrence risk by clinical parameters and/or biomarkers will enable personalized preventive intervention designed toward specific molecular targets. Liver transplantation offers survival benefit comparable to resection for carefully selected patients who meet eligibility criteria based on the extent of tumor spread (Milan criteria). Several attempts have been made to expand the indication for transplantation based on refined individual prognostic prediction (UCSF and Metroticket criteria). These evolving techniques and approaches will enable personalized surgical care of the patients for improved clinical outcomes.
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