外科手术是肝细胞癌（HCC，简称肝癌）病人治疗的首选方案。然而，我国约七成HCC病人初诊时已属于进展期，失去了手术机会。近年来，系统治疗的快速发展为进展期HCC病人带来了新的希望。靶向和免疫（靶免）联合疗法或局部疗法与靶免治疗的联合方案显著改善进展期HCC的生存,改变了进展期HCC的治疗格局。此外，系统治疗也为HCC病人围术期治疗带来新的机遇。转化治疗、新辅助治疗以及术后辅助治疗等有助于增加手术治疗机会、降低术后转移和复发风险、延长HCC病人的总体生存期。以靶免联合治疗为基础的系统疗法已贯穿HCC外科治疗的全流程管理，彻底改变了HCC的外科治疗范式。然而，如何确定最佳组合、筛选敏感人群、解决耐药性以及降低全身不良事件等还需进一步探索。

Surgery is still the first choice for patients with hepatocellular carcinoma(HCC). However, about 70% of HCC patients in China are first diagnosed in the advanced stage and have lost the opportunity for surgery. Recently, the rapid development of systematic therapy has brought new hope for patients with advanced HCC. The combination of molecular targeted therapy and immunotherapy with or without local therapy significantly improves the survival of advanced HCC and alters the landscape of surgical treatment in advanced HCC. In addition, systemic therapy also brings new opportunities for perioperative treatment of HCC patients. Conversion therapy, neoadjuvant therapy, and postoperative adjuvant therapy can increase the chances of surgical treatment, reduce the risk of postoperative metastasis and recurrence, and prolong the overall survival of HCC patients. Systematic therapy based on molecular targeted therapy and immunotherapy has been applied through the whole process of HCC surgical treatment, and has completely altered the surgery paradigm of HCC. However, further research is needed to determine the optimal combination protocol, screen the sensitive populations, address drug resistance, and reduce systemic adverse events.