Liver resection (LR) remains a cornerstone curative option for patients with hepatocellular carcinoma (HCC), and yet the high rate of postoperative intrahepatic recurrence poses a significant clinical challenge. Despite numerous attempts, no adjuvant therapy has shown definitive efficacy in preventing recurrence. In this context, salvage liver transplantation (SLT) and repeat hepatectomy (RH) have emerged as key curative strategies for recurrent disease. While SLT is associated with the most favorable survival outcomes, limited donor availability, particularly in Eastern countries, often necessitates the use of RH, which can also offer promising results. These evolving treatment strategies underscore the urgent need for improved risk stratification, optimized surgical decision-making, and innovative approaches to managing recurrent HCC.