For hepatocellular carcinoma (HCC), surgery-oriented comprehensive treatment is the mainstream approach. Due to the insidious onset, only about one third of the newly diagnosed patients have a chance to receive a radical resection or liver transplantation. There are still controversies regarding the selection of laparoscopic or open surgery, and anatomic or nonanatomic liver resection in the academic community. In addition, the advent of targeted drugs represented by tyrosine kinase inhibitors and the immune checkpoint inhibitors represented by PD-1 antibodies leads the perioperative adjuvant therapy of HCC into a new era. A number of domestic medical centers have reported favorable results in preoperative conversion therapy for patients with initially unresectable advanced HCC, which offers new hope for improving the prognosis of these patients. Moreover, studies are also being actively carried out to evaluate the values of the preoperative neoadjuvant therapy for patients with initially resectable advanced HCC as well as the postoperative adjuvant therapy for HCC patients. Even more, scholars proposed the treatment strategies toward the achievement of no evidence of disease condition in HCC, according to the advances in adjuvant treatment modalities. In general, the therapeutic patterns for the treatment of HCC nowadays are already shifting toward those for the treatment of liver metastases from colorectal cancer. However, there are still a range of outstanding problems that urgently need to be validated by further clinical studies. This article focuses on the current situation of concept innovations and challenges in surgical treatment of HCC.