In patients with advanced hepatocellular carcinoma who responded to systemic therapy, surgical resection significantly prolongs time to treatment failure compared to maintenance therapy.

• Median time to treatment failure was 20.4 months with surgery versus 11.8 months with maintenance therapy (hazard ratio 0.60; p=0.015).
• Adverse events were higher in the surgery group (39%) versus maintenance (21%), with two treatment-related deaths linked to therapy.

Consider surgical resection for selected patients post-systemic therapy to enhance treatment duration before progression.