Primary liver cancer is the fifth most common malignancy worldwide, accounting for the third leading cause of death from tumors, and its five-year natural mortality rate exceeds 95%. More than 500,000 people worldwide develop liver cancer each year, with more than half of them in China [1]. Although there are many effective tools for hepatocellular carcinoma, hepatic resection remains the primary treatment for hepatocellular carcinoma. Because of the insidious onset of the disease, most patients are already at an advanced stage when symptoms are detected, and less than 20% of patients have indications for hepatic resection. However, even if these patients undergo so-called radical resection, more than 50% of them still experience postoperative recurrence and metastasis [2]. Therefore, it has become an urgent mission for medical practitioners, especially hepatobiliary surgeons, to effectively reduce the overall postoperative recurrence rate of hepatocellular carcinoma and to re-intervene patients with postoperative recurrence to prolong their survival and improve their quality of life. There are only three known factors affecting postoperative recurrence of hepatocellular carcinoma: factors from the patient’s tumor, factors from the surgical procedure, and interventions to prevent recurrence after surgery [3]. In the following, I will discuss how to reduce the overall recurrence rate of hepatocellular carcinoma after surgery from these three aspects: First, early diagnosis and early surgical interventions can reduce the overall recurrence rate of hepatocellular carcinoma after surgery. Currently, the surgical technique of hepatectomy is relatively mature, and many large hepatobiliary surgery centers have reported mortality rates of hepatectomy within 3-5%, and some centers have even reported no perioperative deaths for many years [4, 5]. However, as far as hepatic cancer resection is concerned, there are still differences in the choice of surgical indications between the East and the West. In comparison, our range of surgical indications is wider than the criteria established abroad [6, 7]. Some advanced patients with combined portal vein carcinoma thrombosis, bile duct carcinoma thrombosis, or even distant metastases are not considered for surgical treatment at all in most Western hepatobiliary surgery centers, but in our opinion, surgical resection is still actively considered as long as the tumor itself is resectable and the liver functional reserve is still acceptable. We have a group of 511 Barcelona (BCLC) advanced hepatocellular carcinoma undergoing hepatic resection [8], showing overall survival rates of 69.9%, 41.2%, and 30.5% at 1, 3, and 5 years, and tumor-free survival rates of 48.2, 30.3%, and 24.0% at 1, 3, and 5 years, which are significantly better than those reported in Western countries treated with sorafenib or combined medical therapy survival of patients with advanced hepatocellular carcinoma in BCLC. Tumor size, tumor number, presence or absence of an intact envelope, tumor pathological grade, presence or absence of portal vein carcinoma thrombus, and presence or absence of distant metastases have long been shown to be independent risk factors for recurrence after hepatectomy [9]. It seems that on an individual basis, the factors influencing each patient from the tumor itself at the time of performing surgery cannot be modulated, and on this level cannot have an impact on the recurrence rate after hepatocellular carcinoma surgery. However, for the whole population of liver cancer, what we can do to reduce the overall recurrence rate of liver cancer after surgery is to enable more patients to detect the tumor early and to cure it by surgical resection at the early or middle stage of liver cancer. To do so, we need to strengthen scientific education, actively carry out medical checkups and screening, and focus on monitoring hepatitis virus carriers for timely detection and clear diagnosis. When more and more early and mid-stage liver cancers are surgically resected, the overall recurrence rate of liver cancer after surgery will undoubtedly be greatly reduced, which will be a significant and strategic move. We should see that with the development of our society and economic progress, people’s health awareness is increasing, and unit-organized medical checkups and self-checkups are gradually becoming normalized, which is also a good initiative to promote the continuous improvement of the overall efficacy of liver cancer. However, due to the weak propaganda of hepatitis B knowledge, many people do not have enough understanding of hepatitis B transmission and the trilogy of “hepatitis – cirrhosis – liver cancer”, and society is not tolerant enough to hepatitis B carriers, and the dissemination of hepatitis B knowledge is not enough. Some hepatitis B virus carriers know that they are infected with hepatitis B virus, but they still do not pay attention to the necessary routine medical checkups, and only come to the clinic when they have advanced liver cancer and have symptoms of abdominal pain and bloating. These patients with advanced hepatocellular carcinoma, even though they are barely able to undergo liver resection, are particularly common to have recurrent metastases after surgery. We wrote an article in The Lancet in 2011 calling for the elimination of hepatitis B discrimination [10], and we believe that if the whole society comes to care for this special group of hepatitis B virus carriers, so that these patients can view the disease itself positively, get regular checkups and take necessary antiviral treatments, then it will certainly have an indirect and positive impact on the effectiveness of the treatment of liver cancer as a whole in China. Second, improving surgeons’ individual and overall surgical standards is an effective way that can be worked on to reduce the recurrence rate of hepatocellular carcinoma after surgery. There is no doubt that improving the technical level of hepatobiliary surgeons can reduce the postoperative recurrence rate and prolong the tumor-free survival time of liver cancer patients. Minimizing intraoperative bleeding during liver resection, avoiding perioperative blood transfusion, operating strictly according to the tumor-free principle, minimizing direct contact or pressure on the tumor, and ensuring negative or wider hepatic resection margins will help to reduce the postoperative recurrence rate of hepatocellular carcinoma [11, 12]. In addition, we should also achieve a comprehensive understanding of the patient’s general and tumor conditions before surgery to expand the success rate of open resection; and closely observe the changes of the disease after surgery to reduce or avoid the occurrence of postoperative complications. And it has been reported in the literature that the recurrence rate of liver cancer in patients without complications is lower than that in patients with complications. At present, although hepatocellular carcinoma resection surgery can be performed in local and municipal hospitals, most hepatobiliary surgeons or general surgeons there can only perform resection of hepatocellular carcinoma with relatively shallow tumor growth, small tumor and mild cirrhosis. Of course, surgeons need to refine their skills through practice, and they can choose to go to some large hepatobiliary surgery centers in China for further training and improvement through continuous learning. Under the current status of hepatocellular carcinoma treatment, we still advocate to choose resection surgery if possible, and consider other non-radical treatments such as TACE, radiation therapy and molecular targeted therapy if not. We proposed the first international staging standard for resectable liver cancer for Chinese people [7], and named it “Eastern staging”, which we hope can provide some references and suggestions to domestic hepatobiliary surgeons in the selection of indications and prognosis evaluation of liver cancer. Third, finding effective treatments or drugs to prevent recurrence is the fundamental solution to reduce the recurrence rate of hepatocellular carcinoma after surgery. Some randomized controlled trials and meta-analyses have shown that preoperative TACE therapy is ineffective in preventing recurrence of hepatocellular carcinoma after resection [13, 14], and for the preventive effect of postoperative TACE therapy, some foreign studies have shown that it seems not necessarily beneficial for postoperative hepatocellular carcinoma recurrence either [15]. However, I think this issue should be viewed differently because the indications for hepatectomy are different in China and abroad, and the definition of “radical resection of hepatocellular carcinoma” differs in different studies. For a large proportion of our patients with combined portal vein thrombosis or multiple tumors, what we can do is to remove the tumor lesion itself or remove all the thrombosis, or to maximize the remaining hepatic functional reserve and use a combined local resection of multiple tumors, for such postoperative patients, the significance of prophylactic TACE therapy may lie in the possible presence of microscopic tumor lesions in the liver play a role [16]. Therefore, for such patients with multiple high-risk recurrence factors, it is important to confirm the effect of prophylactic TACE on postoperative recurrence by conducting a multicenter randomized controlled study. Studies in our center have shown that perioperative and postoperative antiviral therapy plays an important role in reducing tumor-free survival and overall survival after resection for hepatitis B-associated hepatocellular carcinoma [17]. Hepatic resection itself may cause reactivation of hepatitis B virus in the body, which can cause a decrease in the body’s immune function and thus have an impact on hepatocellular carcinoma recurrence. In addition, we should note that the so-called “recurrence” is actually divided into two cases, one is related to the intrahepatic metastasis of the hepatocellular carcinoma itself, and the other is actually the recurrence of hepatocellular carcinoma. For a patient with a high viral load of hepatitis B-associated liver cancer, it is understandable that antiviral therapy can reduce the level of HBV-DNA in the body, which will obviously inhibit tumor re-initiation in the latter case. The example of antiviral therapy is one of the best examples for the prevention of postoperative recurrence of hepatitis B-associated hepatocellular carcinoma. There are very limited drugs that are clearly able to prevent recurrence of hepatocellular carcinoma after surgery. Thymidine can improve the immune function of the body and may play a role in preventing postoperative recurrence, but there is still a lack of evidence from strict evidence-based medicine. In fact, in the prevention of postoperative recurrence, we can also consider appropriate supplementation with traditional Chinese medicine, which may be able to achieve unexpected results. However, because TCM itself is dialectical, herbal prescriptions vary from person to person, and the mechanism of action is still difficult to be elucidated by the modern medical model, it is difficult to conduct some high-quality randomized controlled studies or to draw conclusions that are convincing to the public. In any case, in order to achieve wide recognition and comprehensive promotion of traditional Chinese medicine in China, it is necessary to take the path of modern development and scientific research, and to prove it with advanced medical concepts. Nowadays, some traditional prescription dispensed Chinese medicines have been developed into proprietary Chinese medicines and have been carried out in clinical randomized controlled trials in our hospital. We expect that these traditional Chinese medicines can play a miraculous role in preventing recurrence of hepatocellular carcinoma after surgery. As we all know, liver cancer is one of the “most complex” diseases requiring multidisciplinary participation, and doctors from liver surgery, transplantation surgery, gastroenterology, medical oncology, Chinese medicine, interventional therapy, radiotherapy, and minimally invasive therapy can all adopt different targeted treatments for liver cancer. Even different doctors of the same specialty sometimes have different treatment views. When a liver cancer patient comes to the hospital, the formulation of treatment plan and the ultimate efficacy are actually related to the physician he sees in the first consultation. In my clinic, I have encountered some patients whose tumors were less than 5 cm in size when they were first discovered, and their physical condition and liver function were excellent, which were the best indications for liver resection. However, the doctors in their local hospitals recommended interventional therapy or radiation therapy instead of surgical resection, so that these patients, who were expected to be cured, lost the best chance of cure, and they waited until the tumor grew up, or had portal vein thrombosis or distant metastasis before seeking other treatment options elsewhere. Therefore, I proposed the concept of standardized treatment for liver cancer at an early stage, and implemented and passed it on in our Eastern Hepatobiliary Surgery Hospital, with the hope that more liver cancer patients can receive reasonable individualized and comprehensive treatment. In addition, I would also like to talk about the issue of “over-treatment”, which is a common phenomenon in the retreatment of liver cancer recurrence after surgery. In my opinion, the concept of “harmony and balance” is worth emphasizing in the overall treatment of tumors, and we need to consider whether the treatment of the tumor itself will bring harm and affect the normal body. If postoperative recurrence of metastasis occurs in liver cancer patients, what treatment plan should be considered at this time? Should it be re-excision, TACE, radiofrequency ablation, radiotherapy, molecular targeted therapy, or Chinese medicine treatment? Or is it a combination of several of these options? Of course, this should be considered according to each patient’s specific situation, but we must be careful not to over-treat the patient, which may damage the normal liver function or cause fatal damage to the organism and affect the patient’s quality of life. In conclusion, there is still a lot of work to be done and a lot of research to be carried out in both basic and clinical research on the issue of postoperative recurrence of liver cancer. I believe that through multidisciplinary collaboration, Chinese scholars will be able to achieve breakthrough results in the research of postoperative recurrence and metastasis of hepatocellular carcinoma for the benefit of our patients!