Liver cancer is a common solid tumor, with insidious onset and rapid progression, it is a malignant tumor that seriously threatens human health. In recent years, with the development of basic and clinical research, the treatment technology of liver cancer has been greatly improved, and liver cancer has changed from the “king of cancer” to partly “curable and controllable”. In this article, we discuss several important issues in the comprehensive surgical treatment of liver cancer. Q: Is there any hope for liver cancer to be cured, and what are the current methods that can cure liver cancer? A: With the improvement of treatment technology in recent years, liver cancer is far from being as terrible as people think. Some early stage liver cancers can be cured clinically after treatment. Among the patients treated in our liver cancer research institute, more than 500 of them have lived a healthy life for more than 10 years, and most of them have not seen any tumor recurrence for many years after surgical treatment, supplemented by post-operative “immunotherapy”, and have completely achieved clinical cure. About 20-30% of all patients seen for liver cancer are suitable for radical treatment methods. These methods include surgical resection, liver transplantation and local treatment. Surgical resection and liver transplantation are used to remove the tumor lesion using surgical means. For some early stage liver cancer, local treatment such as radiofrequency and microwave can be used to achieve complete necrosis of liver cancer lesions, which can also have similar effect as surgical resection. Q: Some patients with liver cancer are found to have invaded the blood vessels of liver and formed vascular cancer thrombus when they visit the doctor, is there any treatment for such advanced patients and how effective is it? A: Hepatocellular carcinoma has the characteristic of easily invading blood vessels, especially invading the portal vein of the liver and forming portal vein thrombosis. Liver cancer with portal vein thrombosis has always been a difficult problem in liver cancer treatment. Through years of clinical and basic research, the Institute of Liver Cancer has made a series of achievements in the formation mechanism and prevention of portal vein thrombosis, and won the Second Prize of National Science and Technology Progress in 2008. For these special patients, there are different treatment methods according to the liver reserve function and the situation of tumor and portal vein cancer embolism. If the tumor is limited to half of the liver and the liver reserve function is good, there is still hope to receive surgical treatment to remove the cancerous thrombus tissue in the portal vein while removing the tumor. And leave a chemotherapy pump in the portal vein, supplemented with heparin and portal vein chemotherapy after surgery, which can significantly improve the treatment effect of portal vein cancer thrombus in hepatocellular carcinoma, and even some patients have obtained long-term survival. For patients who are not suitable for surgery, they can also receive interventional embolization chemotherapy to treat the tumor and radiotherapy to control the cancer embolus in the portal vein at the same time, which can also have better therapeutic effect. Therefore, for such patients, our hospital adopts a multidisciplinary and multi-method comprehensive treatment, hoping to improve the treatment effect to the greatest extent. Q: Is liver transplantation, which can remove the whole diseased liver, the best treatment for liver cancer? Why do some liver cancer patients have recurrence after liver transplantation? Is there no treatment for recurrence? A: Compared with liver resection, liver transplantation has the advantage of removing the diseased liver and eliminating the impact of underlying liver lesions on the survival of liver cancer patients. However, not all liver cancer patients are suitable for liver transplantation treatment. Tumor can recur very quickly after liver transplantation for patients with advanced liver cancer, and the result is very poor. Therefore, liver transplantation has criteria for indications. Through clinical research, the Institute of Liver Cancer of Zhongshan Hospital has proposed the Shanghai recurrence criteria: single tumor diameter ≤9cm; or multiple tumors ≤3 and the largest tumor diameter ≤5cm, the total diameter of all tumors ≤9cm, no large vessel invasion, lymph node metastasis and extrahepatic metastasis, such patients are suitable for liver transplantation with better results and lower recurrence rate. Since most of the recurrence foci may originate from liver cancer cells latent in other parts of the body or surviving in circulation, liver cancer patients still have the risk of recurrence after liver transplantation, but the magnitude of the risk is closely related to the severity of the tumor before transplantation. For liver cancer patients with decompensated cirrhosis, the earlier they have liver transplantation, the lower the recurrence rate may be. Once the tumor recurs after liver transplantation, it is not that there is no treatment available. Since the new liver does not have cirrhosis and has good liver function, it can tolerate various treatments such as interventional, radiofrequency and radiotherapy. There are also appropriate treatments for recurrence in other areas. Q: For primary liver cancer, those suitable for surgery can be removed, but if it is metastatic liver cancer such as intestinal cancer, gastric cancer or breast cancer, can it also be treated surgically? A: The understanding of treatment for metastatic liver cancer has been improving in recent years. Generally speaking, liver metastasis from intestinal cancer, stomach cancer and breast cancer often indicates that the tumor is at an advanced stage. In the past, it was thought that only systemic palliative treatment such as chemotherapy could be used, and there was no indication for surgical treatment. However, clinical practice tells us that for some isolated, or multiple but stable number of lesions for a longer period of time, these liver metastases can also be surgically removed in cases where the primary lesions have been removed, or where the primary lesions can be removed at the same time. The postoperative treatment is then supplemented with systemic chemotherapy, or immunotherapy, etc., which is significantly better than non-surgical conservative treatment. However, metastatic liver cancer is not suitable for liver transplantation because liver metastasis is likely to be only a local manifestation of systemic multiple lesions in the liver, and the immunosuppressed state after liver transplantation may induce the rapid appearance of more metastases, which is counterproductive. Q: Most patients with primary liver cancer are accompanied by chronic liver disease, should the treatment and follow-up of chronic hepatitis after liver cancer surgical treatment also be paid attention to? A: Chronic hepatitis, such as hepatitis B and C, is an important cause of primary liver cancer. After surgical treatment of hepatocellular carcinoma based on hepatitis B, the follow-up and observation of the degree of hepatitis B replication and active hepatitis cannot be neglected. Poor control of chronic hepatitis increases the risk of postoperative hepatic insufficiency and the chance of tumor recurrence. Anti-viral therapy should be administered to patients with chronic hepatitis manifestations and high viral replication status. There are several effective anti-hepatitis B virus drugs, but once used, they cannot be stopped at will. The selection and course of treatment of such drugs must be guided and monitored by a specialist. Q: What are the effective means to prevent metastasis recurrence after primary liver cancer surgical treatment? A: The prevention of recurrence and metastasis after liver cancer surgery is very tricky, so in recent years, our liver cancer research institute has invested a lot of efforts in clinical and scientific research. At present, there are not many clinically effective methods. Preoperative large tumors, multiple tumors, or portal vein thrombosis are high-risk factors for recurrence. Immunomodulatory drugs such as interferon are also effective in some cases, and long-term use may have a preventive effect. Control of the hepatitis virus is also an important part of recurrence prevention. There is not much evidence on whether traditional Chinese medicine has a preventive effect on recurrence, and if it is used, herbs that have an impact on liver function should be avoided, and “warming and toning” should be the mainstay. Advances in basic research have provided new molecularly targeted drugs for the treatment of liver cancer, which differ from traditional chemotherapy by interfering with some molecular targets on cancer cells to treat tumors. “Sorafenib is a new molecularly targeted drug that has proven to be clearly effective in advanced liver cancer, but whether it can prevent metastasis and recurrence of liver cancer still needs to wait for clear results from clinical studies. Therefore, both the treatment of liver cancer and the prevention and treatment of metastasis and recurrence should be a multi-step and multi-modal integrated intervention to achieve the best treatment effect.