Treatment of hepatocellular carcinoma (HCC) remains a critical issue particularly in the endemic areas. This paper summarizes the literature in the recent 4 years and the author's data. Substantial progress has been found in the treatment of HCC during the recent decades, which was mainly a result of advances in medical imaging, aggressive surgical approach, regional cancer therapies and multidisciplinary approach. Surgical approaches that resulted in significant prolonged survival included: resection (particularly small HCC resection), re-resection for subclinical recurrence, cytoreduction and sequential resection for initially unresectable HCC, and liver transplantation for small HCC. In nonsurgery, regional cancer therapy has been a new trend, which includes transcatheter arterial chemoembolization, percutaneous ethanol injection for small HCC, and others. As a result of multimodality combination treatment and changing concepts in surgical oncology, the role of surgery in the treatment of HCC has become bigger. However, the inadequacy of regional cancer therapies, its multicentric origin and tumor invasiveness remain major targets to be studied for a curative treatment.