Objective:  To explore the surgical treatment for large primary liver cancer.
Methods: The clinical data of 109 patients with large primary liver cancer undergoing hepatectomy were retrospectively reviewed.
Results: The maximum diameters of the tumors  ranged from 10.5 to 30 cm with the average of (14.46±3.84) cm, and 92 cases were single and 17 cases were multiple lesions. The tumor location was within the left lobe in 41 cases, right lobe in 63 cases and entended over half of the liver in 5 cases. Eighty-three cases were combined with posthepatitic cirrhosis, 5 cases complicated by rupture and bleeding of the liver cancer, 19 cases had tumor embolus of portal vein (4 cases with tumor embolus of bile duct) and 15 cases had metastasis to the hilar or juxta-hepatic  lymph nodes. The preoperative liver function grade was Child's grade A in 101 cases and grade B in 8 cases. The AFP levels of 98 cases were higher than 500 μg/L and in 11 cases were below 20 μg/L. Two cases were in clinical stage IIa, 92 cases in stage IIb and 15 cases in stage IIIa. Forty-two cases underwent anatomic liver resection and 67 cases underwent local resection, and the intraoperative blood loss was 400-2, 200 mL. No hospital death occurred, and the incidence of postoperative complications was 75.23%. Sixty-eight cases were followed up for 2 to 72 months, of whom the 5 cases with rupture and bleeding of the liver cancer survived for 8 to 13 months after surgery, and the 1-, 3-, and 5-year survival rate of the remaining 63 cases without tumor rupture was 44.07%, 13.06% and 7.84%, respectively after elective hepatectomy. 
Conclusion: Surgical treatment offers effective short-term in results patients with large primary liver cancer, but its long-term efficacy remains to be improved. One-stage resection may be feasible for ruptured large primary liver cancer in selected cases.