As early as in the mid-1950s, surgical treatment of primary liver cancer has been carried out in China. In the past half century, through the joint efforts of several generations, the surgical treatment of primary liver cancer has developed greatly and achieved better results. In today’s liver surgery, there is no longer a restricted area for surgery, nor is it considered that giant liver cancer cannot be removed. At present, there is a worldwide consensus that surgical resection is still the first choice and the most effective measure for the treatment of this disease. Meanwhile, due to the rapid development of modern science and technology, some new treatment techniques have emerged one after another, which are continuously promoted and applied in clinical practice and have achieved certain effects. These techniques include: radiation interventional therapy, radiofrequency therapy, X-ray knife therapy, cryotherapy, microwave therapy, anhydrous ethanol (alcohol) intra-tumor injection therapy, etc. Clinical experience shows that these techniques are used for the treatment of the most common types of cancer. Clinical experience shows that these techniques have been used in the treatment of primary liver cancer, and there is a phenomenon of inappropriate selection of indications. As a result, some cases have missed the opportunity of reasonable surgical treatment or even cure, which has caused irreversible consequences to some patients. There is no unified reference standard in China on how to choose reasonable treatment for primary liver cancer patients. In recent years, many doctors in China have suggested to us that an authoritative national reference program should be developed. In this regard, under the encouragement and guidance of academicians Qiu Fazu and Wu Mengchao, the Preparatory Committee of the 6th National Conference on Liver Surgery drafted a draft on “Selection of Surgical Treatment for Primary Liver Cancer”, which was revised by 12 famous liver surgeons in China and published in the 6th National Conference on Liver Surgery held in Wuhan from October 25 to 28, 2000. During the 6th National Liver Surgery Conference held in Wuhan from October 25 to 28, 2000, the draft was discussed and adopted by the experts of the Liver Surgery Group of the Chinese Society of Surgery. The full text of the selection scheme is published below as a reference for the surgical community in China to choose the treatment method for primary liver cancer in the future. In the process of developing this option, we have received the support and assistance from academicians Jiangyou Tang and Zhiqiang Huang. 1. Indications for surgical resection of primary hepatocellular carcinoma 1. 1 General condition of patients ① Patients in good general condition, no obvious organic lesions of heart, lung, kidney and other important organs; ② Liver function is normal, or only mildly impaired, according to the liver function classification of grade I, or liver function classification of grade II, after short-term liver care treatment has improved significantly, liver function returned to grade I (see the table for liver function classification); ③ Liver reserve function (such as ICG, r15) in normal range; ④ No extensive extrahepatic metastatic tumors. 1.2 Local lesions 1.2.1 Radical hepatectomy can be performed in the following cases: ① single small hepatocellular carcinoma (diameter ≤2cm); ② single small hepatocellular carcinoma (diameter >2cm, ≤5cm); ③ single large hepatocellular carcinoma (diameter >5cm, ≤10cm) or large hepatocellular carcinoma (diameter >10cm) with extrahepatic growth, smooth surface, clear surrounding boundary, and less than 30% of liver tissue destroyed by tumor; ④ single large hepatocellular carcinoma (diameter >5cm, ≤10cm) or large hepatocellular carcinoma (diameter >10cm) with smooth surface, clear surrounding boundary, and less than 30% of liver tissue destroyed by tumor. ④ Multiple tumors with less than 3 nodes confined to one segment or one lobe of the liver. 1. 2. 2 The following cases can only be treated with palliative hepatectomy ① 3 to 5 multiple tumors beyond half of the liver with multiple limited resections, or tumors confined to 2 to 3 adjacent liver segments or half of the liver with significant compensatory enlargement of tumor-free liver tissue of more than 50% of the whole liver on imaging; ② large hepatocellular carcinoma (diameter > 5 cm, ≤ 10 cm) or giant hepatocellular carcinoma (diameter > 10 cm) in the left or right half of the liver with clear borders. ②Large hepatocellular carcinoma (diameter > 5 cm, ≤ 10 cm) or giant hepatocellular carcinoma (diameter > 10 cm) in the left or right hemisphere with clear borders and no invasion of the first or second hepatic hilum, with significant compensatory enlargement of the tumor-free side of the liver and more than 50% of the whole liver; ③Large hepatocellular carcinoma located in the central region of the liver (middle lobe, or segments IV, V, VIII), with significant compensatory enlargement of the tumor-free liver and more than 50% of the whole liver; ④Large hepatocellular carcinoma or giant hepatocellular carcinoma in segments I or VIII; ⑤Lymph node metastasis in the hepatic hilum, If the primary liver tumor can be resected, the tumor should be resected and the lymph nodes in the hilar area should be cleared at the same time; if the lymph nodes are difficult to be cleared, radiation therapy can be performed after surgery; ⑥ If the surrounding organs (colon, stomach, diaphragm or right adrenal gland, etc.) are invaded, if the primary liver tumor can be resected, the tumor and the invaded organs should be removed together. For single metastatic tumor of distant organs (such as single lung metastasis), resection of primary liver cancer and metastases can be performed simultaneously. 2. Indications for primary hepatocellular carcinoma combined with portal vein thrombosis and/or vena cava thrombosis 2. 1 General conditions of the patient The requirements are the same as those for hepatectomy. 2. 2 Local conditions 2.2 Local conditions ① The tumor is resectable according to the criteria of indications for hepatectomy for primary hepatocellular carcinoma; ② The cancer thrombus fills the main branch or/and trunk of portal vein, and further development will soon endanger the patient’s life; ③ It is estimated that the formation of cancer thrombus is relatively short, and no mechanization has occurred yet. The above cases are suitable for portal vein trunk dissection to remove the cancer thrombus and palliative hepatectomy at the same time. If the cancer thrombus is located in a small portal vein branch above the liver segment, it can be removed together with the portal vein branch at the same time of resection of the liver tumor. If the tumor is found to be unresectable during surgery, it can be treated by intraoperative selective hepatic artery cannula embolization chemotherapy or portal vein cannula chemotherapy, cryotherapy or radiofrequency treatment after the portal vein trunk is cut to remove the embolus. In case of combined with vena cava thrombosis, the vena cava can be cut to remove the thrombosis and the liver tumor can be removed under the blockage of whole liver blood flow. 3.Surgical indications for primary hepatocellular carcinoma combined with bile duct cancer embolism 3.1 General condition of patients The basic requirements are the same as hepatectomy. It should be noted that this patient has obstructive jaundice, so the liver function classification cannot be completely judged according to the schedule, and the patient’s general condition, A/G ratio and prothrombin time should be emphasized. 3.2 Local conditions ① The tumor is resectable according to the criteria of indications for hepatectomy for primary hepatocellular carcinoma; ② The cancer thrombus is located in the left or right hepatic duct, common hepatic duct, or common bile duct; ③ It is estimated that the formation of the cancer thrombus is relatively short and has not yet been mechanized; ④ The cancer thrombus has not invaded the bile duct branches above the second level on the healthy side. The above cases are suitable for choledochotomy to remove the cancer embolus and palliative hepatectomy at the same time. If the cancer embolus is located in a small branch of the hepatic duct above the hepatic segment level, it can be resected together with the hepatic tumor at the same time, without removing the embolus through choledochotomy. If the tumor is found to be unresectable, intraoperative chemotherapy with selective hepatic artery cannulation, cryotherapy or radiofrequency therapy can be performed after the resection of the common bile duct to remove the cancer embolus. 4.Case selection of radiofrequency, cryotherapy and microwave therapy 4.1 General condition of patients ①Patients are in good general condition, no obvious organic lesions of heart, lung, kidney and other important organs, good functional status or only mild damage; ②Liver function is normal, or only mild damage, according to liver function classification is grade I or II. 4. 2 Local conditions ① single tumor, or less than 5 cancer foci, tumor diameter less than 5 cm; ② recent recurrence of liver cancer after hepatectomy, not suitable or the patient does not want to undergo another hepatectomy. These techniques can be performed by B-ultrasound-guided percutaneous hepatic aspiration or can be applied during surgery. The use of these techniques for hepatic trauma treatment during hepatectomy can not only destroy the remaining cancer cells at the trauma, but also help to stop the bleeding of the trauma, which increases the safety of the operation. 5. Selection of cases for intratumoral injection of anhydrous ethanol (alcohol) 5. 1 General conditions of patients ① Patients are in good general condition, without obvious organic lesions of heart, lung, kidney and other important organs, or have organic lesions of heart, lung, kidney and other important organs and are in poor functional condition; ② Liver function is obviously impaired and unsuitable for hepatectomy. 5. 2 local conditions ① single tumor or multiple nodular tumors, but no more than 5 cancer foci; ② recent recurrence of hepatocellular carcinoma after hepatectomy, which is not suitable or the patient is not willing to undergo hepatectomy again. 6. Indications for surgery for primary hepatocellular carcinoma combined with hepatic sclerosis and portal hypertension 6. 1 General condition of patients ① Patients in good general condition, no significant organic lesions of heart, lung, kidney and other important organs; ② Normal liver function, or only mild damage, according to the liver function grade Ⅰ, or liver function grade Ⅱ, after short-term liver care treatment has improved significantly, liver function returned to grade Ⅰ (see the table for liver function grade); ③ Liver reserve function (such as ICG) ③ Liver reserve function (e.g. ICG, r15) in normal range; ④ No extra-hepatic metastatic tumor. 6.2 Local conditions 6.2.1 Resectable hepatocellular carcinoma ①Patients with obvious splenomegaly and hypersplenism (e.g., WBC less than 3 × 109/L, platelets less than 50 × 109/L) can undergo splenectomy at the same time; ②Patients with obvious esophageal and fundic varices, especially those who have had hemorrhage from ruptured esophagogastric varices, can be considered for peri-pancreatic vascular dissection at the same time; patients with severe gastric mucosal lesions, such as those who have been operated on, can be considered for surgery. In patients with severe gastric mucosal lesions, splenorenal shunts or other types of selective portosystemic shunts should be performed if the patient’s intraoperative condition permits. 6.2.2 For unresectable hepatocellular carcinoma found intraoperatively ① with obvious splenomegaly and hypersplenism (e.g., WBC less than 3 × 109/L, platelets less than 50 × 109/L) without obvious esophageal or fundic varices, intraoperative selective hepatic artery cannulation embolization chemotherapy, cryotherapy or radiofrequency therapy should be performed along with splenectomy; ② with obvious esophageal or fundic varices, especially those with previous esophagogastric varices If there is a significant esophageal or fundic varices, especially if there has been a hemorrhage of the esophagogastric varices and there is no serious gastric mucosal lesion, splenectomy or splenic artery ligation with coronary vein suture can be performed; whether to perform dissection is decided according to the patient’s intraoperative observation. Then, intraoperative radiofrequency or cryotherapy should be performed; hepatic artery cannulation embolization chemotherapy is not appropriate. Appendix I Suggestions for selecting cases for hepatic artery embolization chemotherapy (HACE) by radio-interventional method 1. General condition of patients ①Patients are in good general condition, no obvious organic lesions of heart, lung, kidney and other important organs; ②Liver function is normal or only mildly impaired, and liver function is graded as grade I or II. 2. Local conditions ① the tumors are multiple and scattered in the left and right halves of the liver; ② the tumors are large, but the tumor-free side of the liver does not have compensatory enlargement, and the volume is less than 50% of the whole liver; ③ although the tumors are small, there is severe hepatic sclerosis, and the volume of the whole liver is obviously reduced; ④ there is no cancer thrombus in the portal vein of the healthy side of the liver, or there is cancer thrombus, but there is still blood flow through the portal vein branches; ⑤ there is no cancer thrombus in the intrahepatic bile duct and extrahepatic bile duct; ⑥ If the tumor has recently recurred after hepatectomy for hepatocellular carcinoma, and the patient is not suitable for or unwilling to operate again. In principle, preoperative radiological intervention is not required for resectable hepatocellular carcinoma. 1. General condition of patients ① Patients with good general condition, no obvious organic lesions of heart, lung, kidney and other important organs; or organic lesions of heart, lung, kidney and other important organs with poor functional status; ② Liver function is obviously damaged and not suitable for hepatectomy; ③ No obvious splenomegaly and hypersplenism (e.g. WBC less than 3 × 109/L, platelet less than 50 × 109/L). (3) No obvious splenomegaly and hypersplenism (e.g. WBC less than 3 × 109/L, platelet less than 50 × 109/L). (2) Local conditions ① single tumor with diameter less than 3.0 cm; ② small recurrent cancer foci after hepatectomy, which are not suitable or the patient does not want to undergo hepatectomy again.