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The consensus based treatment algorithm recommended by Japan Society of Hepatology consists of extrahepatic lesions, hepatic functional reserve, vascular invasion, number of tumors, and tumor diameter. Treatment is classified into curative treatment (resection, local ablation), TACE, arterial infusion chemotherapy, liver transplantation, and best supportive care. A consensus-based algorithm is not always based on evidence, but involves routinely employed treatment of which a consensus has been reached in Japan. Initially, resection or local ablation therapy should be carried out to treat three or less tumors measuring >3 cm in diameter without extrahepatic lesions/vascular invasion in which the liver function is good. In this group, the prognosis of curative treatment may be favorable. In three or less lesions measuring 13 cm in diameter, resection or TACE is recommended. Curability may be improved by adding ablation therapy to previous transarterial treatment. Secondly, TACE and arterial infusion chemotherapy are recommended to treat four or more lesions. However, arterial infusion chemotherapy is carried out based on expert experience, but there is no solid evidence because there is no randomized, controlled trial. The combination of local ablation therapy and TACE/arterial infusion chemotherapy for five to six or less lesions is beneficial in some cases. Furthermore, resection may be considered for such lesions if possible. In young Child-Pugh A/B hepatic functional reserve patients with early recurrence, liver transplantation is sometimes the choice of treatment when they meet the Milan criteria. In the presence of vascular invasion, resection is carried out for patients with third or fourth branch of portal venous invasion if possible. In such patients, TACE can be a choice of treatment. In patients with main trunk or first branch of portal vein, arterial infusion chemotherapy, in addition to hepatic arterial infusion chemotherapy with implanted port, is a choice of treatment.

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