Preoperative conversion therapy significantly enhances surgical outcomes for intermediate-stage hepatocellular carcinoma.

• 23.2% of patients in the conversion resection group achieved a complete pathological response.
• Microvascular invasion rates were lower in the conversion group (17.9% vs. 58.6% in direct resection).

Consider conversion therapy to improve pathology and survival before resection in select patients.

• 51.8% of the conversion resection group showed a major pathological response.