Abstract: Hepatocellular carcinoma (HCC) is the most common liver cancer type. In China, approximately 70% of patients with HCC are diagnosed at an intermediate or advanced stage, losing the opportunity for curative surgical resection, resulting in a low five-year survival rate. Conversion therapy, an important treatment strategy, aims to transform initially unresectable HCC into a resectable state via systemic or local therapeutic approaches, thereby providing the patients with the potential for full recovery. With the continuous emergence of novel treatment regimens, such as immune checkpoint inhibitors combined with targeted drugs, and the increasing maturity of multidisciplinary team (MDT) collaboration models, the overall response rate to HCC treatment has substantially improved. Thus, conversion therapy is essential for advancing intermediate-to-advanced HCC therapies for potential curability. The key factors in achieving R0 resection and prolonging long-term survival include the precise selection of suitable patient populations, adoption of efficient combination therapies, optimal timing for surgical intervention, and implementation of perioperative integrated management strategies. Despite the promising prospects for conversion therapy in HCC management, high-quality randomized controlled clinical trials are needed to further validate the optimal therapeutic strategies and improve long-term follow-up data on efficacy outcomes. This review aimed to systematically summarize the major current strategies for conversion therapy in HCC and also explore their application in clinical practice to provide reference guidance for hepatobiliary surgeons.