Cryoablation (CRA) is currently an effective radical treatment for primary liver cancer (hepatocellular carcinoma). It induces tumor cell necrosis, microvascular damage, and immune activation through ultra-low temperatures, offering advantages of precise ablation and protection of critical anatomical structures. For small hepatocellular carcinoma (maximum diameter ≤3 cm), its efficacy is comparable to that of radiofrequency ablation (RFA) and microwave ablation (MWA), with a lower complication rate when tumors are adjacent to high-risk sites such as blood vessels or the gallbladder. For tumors measuring 3-5 cm in diameter, CRA is associated with a lower local recurrence rate than RFA and MWA, along with milder pain response. In large hepatocellular carcinoma (maximum diameter ≥5 cm), combination with transarterial chemoembolization/hepatic arterial infusion chemotherapy is required to improve control rates. CRA can trigger an immune response and exhibits a synergistic effect with immune checkpoint inhibitors. Animal studies and preliminary clinical research confirm its safety and anti-tumor activity; however, high-level evidence -based medicine evidence is still needed to verify its efficacy in hepatocellular carcinoma. Future efforts should focus on identifying biomarkers for combination therapy, developing individualized strategies, and exploring optimized multimodal treatment regimens.