The incidence and death rate of primary liver cancer in China account for more than 50% of the world, and it has its own characteristics. There are many treatment methods and lack of unified standardization. For this reason, the Department of Medical Affairs of the Ministry of Health of China has organized multidisciplinary experts to conduct in-depth discussions and revised the Diagnostic and Treatment Standards for Primary Liver Cancer, which has been formally announced, and it is expected to actively promote the standardized treatment of primary liver cancer (mainly referring to hepatocellular carcinoma, HCC) in China. 1. Surgical treatment: including hepatic resection and liver transplantation 1.1 Basic principles of hepatic resection This guideline emphasizes the safety of following the principles of maximum complete resection of the tumor, making the margins of the incision without residual tumor thoroughness and maximum preservation of the normal liver tissues, and decreasing the mortality rate and complications of the operation. The efficacy of hepatic resection for early-stage HCC (single lesion, <5 cm in diameter, without intrahepatic metastasis and macrovascular invasion) is obvious, and the 5-year survival rate of surgical resection has increased significantly over the past 10 years to nearly 80% [1]. Therefore, hepatic resection is preferred for well-compensated early HCC. In intermediate and advanced HCC, most of the tumors are single tumors >10 cm in diameter, multiple tumors, with portal or hepatic vein cancerous embolism or bile duct cancerous embolism, and only a small portion of them are suitable for surgery. Preoperative selection and evaluation, improvement of surgical details and postoperative recurrence and metastasis prevention and treatment are the keys to improve the efficacy. Preoperative comprehensive evaluation of liver function such as Child-Pugh classification and ICG clearance test are often used, and CT and/or MRI are used to calculate the volume of residual liver. 1.2 Classification of hepatectomy methods includes radical and palliative resection. This guideline classifies radical resection into 3 grades according to the degree of surgical perfection: Grade I refers to complete resection of the tumor seen with the naked eye, with no residual cancer at the margins; Grade II requires 4 additional conditions on the basis of Grade I: (1) the number of tumors is less than 2; (2) there is no thrombus of the main trunk of the portal vein and its first-grade branches, the common hepatic duct and its first-grade branches, the main trunk of the hepatic vein and the inferior vena cava; (3) there is no metastasis to the hepatic hilum; (4) there is no extra-hepatic metastasis. The criterion is to add the negative condition of postoperative follow-up result on the basis of grade II, i.e., for those who have increased AFP before operation, AFP should be reduced to normal and no tumor residue is seen in imaging examination within 2 months after operation. 1.3 Indications for hepatectomy 1.3.1 Basic conditions of patients The general condition is tolerable, the liver lesion can be resected, and the reserved liver can be compensated. Specifically include: good general condition, no obvious organic lesions of heart, lung, kidney and other important organs; Child-PughA grade of liver function, or A grade after short-term treatment; liver reserve function (such as ICG-R15) is basically normal; and there is no unresectable extrahepatic metastatic foci. 1.3.2 Localized lesions for radical hepatic resection must meet the requirements of ① single hepatocellular carcinoma with smoother surface, clearer boundaries or pseudo-envelope, and <30% of the involved liver tissue; or although >30%, the liver on the anaplastic side is compensated for by an increase in size of 50% or more of the standard liver volume; ② multiple tumors, with <3 nodules, and confined to a segment or a lobe. 1.3.3 Laparoscopic hepatectomy Mainly used for isolated cancerous foci, <5 cm, located in liver segments 2-6; it has the advantages of less trauma, less blood loss and low surgical mortality [2]. 1.3.4 The local lesions of palliative hepatectomy must meet the requirements of ① 3~5 tumors, beyond the range of half liver, multiple limited resection; ② tumors are confined to the adjacent 2~3 liver segments or within half liver, the compensatory enlargement of the tumor-free liver tissues reaches more than 50% of the standard liver volume; ③ hepatocellular carcinoma of the central region of the liver (the middle lobe or segments IV, V, VIII), the compensatory enlargement of the tumor-free liver tissues reaches more than 50% of the standard liver volume; ④ the lymph nodes in the hilar area, the lymph nodes in the portal area of the liver, the lymph nodes in the portal area of the liver; ④ the lymph nodes in the portal area of the liver are not in the liver. For those with lymph node metastasis in the porta hepatis, lymph node dissection or postoperative treatment can be performed at the same time; ⑤ Those with invasion of peripheral organs should be resected together. For those with portal vein thrombus, if the tumor is confined to half of the liver and the thrombus is expected to be removed intraoperatively, the tumor can be resected and the thrombus can be removed through the portal vein, and then hepatic artery chemoembolization (TACE) and portal vein chemotherapy can be carried out after the operation. With vena cava embolism, the vena cava can be cut open to remove the embolus and the tumor can be resected under total hepatic hemorrhage blockage. Combined with bile duct cancer embolism may cause obvious jaundice. If the tumor can be resected and the embolus can be removed, jaundice can be relieved soon, so it is not a contraindication for surgery.For those with HCC combined with cirrhosis and portal hypertension, if the hepatocellular carcinoma can be resected, and if there is obvious splenomegaly and hypersplenism, spleen can be resected at the same time; if there is obvious esophagogastric fundal vein varices, especially if there is rupture of variceal vein with haemorrhage, cardia vascular isolation can be done at the same time; if there is serious gastric mucous lesions, splenic-kidney shunt or other elective portal shunts can be done. If liver cancer is unresectable, with obvious splenomegaly, hypersplenism, and no obvious esophagogastric fundal vein varices, selective hepatic artery embolization and chemotherapy, cryotherapy or radiofrequency can be performed during splenectomy; if there are obvious esophagogastric fundal vein varices, especially those who have had rupture of varicose vein with haemorrhage, and there is no serious gastric mucous membrane pathology, splenectomy or splenic artery ligation with coronary vein suture can be performed; hepatic cancer can be treated with intra-operative radiofrequency or cryotherapy, and it is not suitable to perform chemotherapy with hepatic artery cannula embolization. 1.4 Contraindications to surgery 1.4 Contraindications to surgery: ① poor cardiopulmonary function or other important organs and systems combined with serious diseases, those who can not tolerate surgery; ② severe cirrhosis, liver function Child-Pugh class C; ③ extrahepatic metastasis. 1.5 Liver transplantation is mainly used for small hepatocellular carcinoma combined with severe cirrhosis. However, those with venous cancer thrombus, intrahepatic dissemination or extrahepatic organ metastasis should be contraindicated. Domestic indications for HCC liver transplantation further expand the indications on the basis of internationally recognized Milan criteria and UCSF criteria, and multiple selection criteria are proposed, which are yet to be agreed upon on the basis of symptomatic medicine. Due to the shortage of liver sources and other factors, this guideline does not recommend liver transplantation in patients with good liver function who can tolerate hepatic resection for the time being. 2.Local ablation therapy Image-guided localization, using physical or chemical methods to directly kill the tumor. It mainly includes radiofrequency, microwave, cryotherapy, high-power ultrasound focused ablation and anhydrous ethanol injection therapy. Image-guided techniques include US, CT and MRI, and the treatment pathways include percutaneous, transperitoneal laparoscopic and transabdominal surgery. 2.1 Indications Single tumor with maximum diameter ≤5cm; or ≤3 tumors with maximum diameter ≤3cm. no invasion of blood vessels, bile ducts and adjacent organs as well as distant metastasis. Liver function Child-Pugh class A or B, or after treatment to achieve this standard. For unresectable single tumors with a diameter >5cm, or multiple tumors with a maximum diameter >3cm, ablation as part of palliative comprehensive treatment can improve the efficacy [3], but it needs to be strictly controlled. 2.2 Contraindications ① Huge tumor or diffuse hepatocellular carcinoma; ② Cancer thrombosis of portal vein trunk to secondary branches or hepatic vein thrombosis, invasion of neighboring organs or distant metastasis; ③ Tumor located on the dirty side of the liver, in which more than 1/3 of it is externally exposed; ④ Liver function of Child-Pugh class C, which can not be improved by hepatoprotective therapy; ⑤ Rupture and bleeding of esophagogastric fundal vein varices in the month prior to the treatment; ⑥ Irreparable coagulation disorders and Obvious blood abnormalities, with obvious bleeding tendency; ⑦ persistent large amount of ascites, malignant fluid; ⑧ combined with active infection, especially biliary system inflammation, etc.; ⑨ liver, kidney, heart, lung and brain and other important organs failure; ⑩ consciousness disorder or can not cooperate with the treatment. Tumor in the first hilar region is a relative contraindication; tumor close to the gallbladder, gastrointestinal, diaphragm or protruding from the hepatic peritoneum is a relative contraindication to percutaneous perforation; intrahepatic lesions with extrahepatic metastases are not absolute contraindications, and sometimes they can be used to control the local lesions.