Personalised decision-making in hepatocellular carcinoma: conceptual evolution over two decades ➡️doi.org/10.1093/bjsopen/zrag… Evidence-based medicine was conceived to integrate best available evidence, clinical expertise, and patient values, yet in many fields it has come to be equated with rigid guideline algorithms. This narrative, conceptual review draws selectively on landmark staging frameworks, guidelines, and methodological literature to trace two decades of decision-making in hepatocellular carcinoma across a sequence of schematic frames: stage-centred algorithms, recognition of differential treatment effects, multiparametric expert deliberation, and dynamic, time-dependent bidirectional strategies reinforced by immune checkpoint inhibitor combinations. The trajectory culminates in explicit acknowledgement of irreducible uncertainty, with the multiparametric therapeutic hierarchy positioned at the interface between baseline and treatment-conditioned prognosis and aligned with GRADE evidence-to-decision principles. The authors conclude that hepatocellular carcinoma exemplifies personalised decision-making in complex multidisciplinary care, where transparency about what is known, what is uncertain, and where value judgements enter is preferable to further algorithmic refinement. 👏👏👏@Vaital73, Gordon Guyatt, Masatoshi Kudo, Laura Kulik, David J Pinato, Laura Crocetti, Edoardo G Giannini, @prof_cillo #SoMe4Surgery #MedTwitter #SurgEd #Surgery @BJSAcademy @BJSurgery #HPBSurgery #LiverSurgery #HCC #SurgicalOncology #EvidenceBasedSurgery