In the past half-century, there has been great advancement in the surgical treatment of primary hepatocellular carcinoma (HCC). Liver surgery techniques have improved greatly, and there is not a liver region that cannot be surgically treated. Huge HCC and HCC in special sites (close to the first, second, and third porta hepatis or inferior vena cava) can all be safely resected. Liver transplantation could achieve a good prognosis in HCC patients within the Milan or UCSF criteria. Surgery is now the preferred treatment for early-stage HCC. In addition to surgical treatment, other new local treatment techniques such as TACE, ablation (radiofrequency ablation, microwave ablation, cryotherapy, and percutaneous ethanol injection), stereotactic body radiation therapy, and internal radiotherapy have also been gradually adopted in clinical practice. Upon entering the twenty-first century, there has been a breakthrough in the systemic treatment of HCC as tyrosine kinase inhibitors (TKIs) led to positive outcomes in unresectable patients with advanced HCC. Furthermore, immune checkpoint inhibitors represented by anti-programmed death-1 (PD-1) antibody combined with TKI have also demonstrated promising efficacy in the treatment of advanced HCC. While increased treatment options have brought great hope to patients, how to select an optimal treatment that brings maximum benefit to the patients remains a key issue in clinical practice.