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AimsPrognostic analysis of hepatocellular carcinoma (HCC) in the cirrhotic patient undergoing hepatic resection is necessary in order to determine the clinical effect of hepatectomy on prognosis. Patients and methods:Univariate and multivariate retrospective analyses were performed in 51 cirrhotic patients (38 men, 13 women; mean age 65 years, range 43–81 years) with supervening HCC undergoing hepatic resection between January 1993 and December 1997.ResultsSegmental liver resection was performed in 39 patients (76%) with non-anatomical (wedge) resections in the remainder of cases. The post-operative mortality rate was 8%. The tumours recurred in 23 patients (45%), with 12 patients (52% of recurrences) recurring within 1 year of surgery and 22 patients (96% of recurrences) within 3 years. Recurrent disease was most frequently intrahepatic (22 patients). Significant risk factors for recurrence were micro/macro vascular invasion, and symptoms. Conclusions:The recurrence rate of hepatocellular carcinoma in patients with cirrhosis undergoing surgical resection alone is high and actuarial survival at 4 years is low. Other approaches to the treatment of hepatocellular carcinoma in patients with cirrhosis require consideration.