Primary liver cancer is one of the prevalent malignant neoplasm in China, characterized by a high incidence rate and a dismal prognosis. Upon diagnosis, the majority of patients have progressed to an advanced or intermediate stage, rendering radical surgery impracticable. With the advent and ongoing advancement of translational therapy, the prognosis of patients with middle- to late-stage unresectable hepatocellular carcinoma has been substantially enhanced through the successful conversion of this disease from unresectable to surgically resectable. At present, the primary clinical treatment options for transformative conditions consist of local therapy, systemic therapy, or a combination of the two. This article examines and anticipates the diverse facets of the conversion treatment options for initial unresectable hepatocellular carcinoma, surgical indications and timing following treatment, and postoperative adjuvant therapy.