Objective: To investigate the clinical value and therapeutic effect of reduced-size hepatectomy on advanced huge hepatic alveolar echinococcosis (HAE). Methods: The clinical data of 4 patients with advanced giant HAE and with difficulty to achieve radical resection who underwent reduced-size liver resection from August 2010 to February 2011 were analyzed. For all patients, comprehensive assessments were made before operation, indications and timing for operation were strictly controlled, accurate and precise procedures were performed during operation, and anti-echinococcosis therapy was initiated postoperatively with oral administration of albendazole (ABZ). Results: Operations were successfully performed in all the 4 patients. The median operative time was 267.5 min (210–320 min), median intraoperative blood loss was 737.5 mL (600–950 mL) and the median red blood cell transfusion requirement was 4.0 U (2–6 U), respectively. The mean follow-up was 10 months (8–14 months), during which 1 case developed biliary fistula of the residual hydatid cavity, and 1 case had residual cavity hydrops. The previous obstructive jaundice and lower extremity edema of the patients were all relieved, and no intrahepatic dissemination or death occurred. Conclusion: Reduced-size liver resection provides a feasible technical approach for treatment of advanced giant HAE when it is difficult to implement radical treatment. Strict adherence to surgical indications and timing as well as regular administration of anti-echinococcosis drugs are effective measures to prevent the recurrence and dissemination of HAE.