Precision surgical oncology for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a heterogeneous tumor–liver–host disease in which treatment selection depends on tumor burden, liver function, portal hypertension, performance status, and patient preferences. Although hepatic resection and other established treatment modalities remain central to curative and disease-controlling strategies, emerging biological and digital technologies may provide additional information beyond conventional clinical assessment. However, their prognostic performance does not necessarily establish clinical utility, and many remain insufficiently validated for routine treatment selection. This narrative review examines the evolving role of precision-oriented approaches in HCC, including molecular and immune profiling, radiomics, circulating tumor DNA, artificial intelligence, and digital pathology. We classify these approaches into three evidence tiers: established clinical practice, investigational clinical tools, and future hypotheses. We then propose Precision Surgical Oncology as an author-developed, hypothesis-generating framework in which guideline-based assessment is followed by biological and host-risk refinement, multidisciplinary interpretation, individualized treatment within established therapeutic pathways, and longitudinal reassessment. Precision Surgical Oncology is intended to complement, rather than replace, evidence-based HCC management. Its future clinical value will depend on prospective validation, reproducibility, defined clinical actionability, equitable implementation, and demonstration of improved patient outcomes.