Objective: To evaluate the clinical significance of determination of the preoperative level of total bile acid (TBA) in hepatocellular carcinoma (HCC) patients. Methods: The clinical data of 176 HCC patients undergoing surgical treatment were retrospectively analyzed. Of the patients, 173 cases had Child-Pugh A and 3 cases had Child-Pugh B liver function. The sensitivity of the preoperative TBA level and other liver function indexes in estimating liver cirrhosis, and the relationship between preoperative TBA level and operative complications were analyzed. Results: Eighty-eight patients were diagnosed with liver cirrhosis and 6 cases among the non-cirrhotic patients were diagnosed as Knodell stage S4 by postoperative pathology, and surgery-associated complications occurred in 27 patients (15.3%) in the entire group. Compared with non-cirrhotic patients, the preoperative TBA level in patients with liver cirrhosis was significantly increased (P<0.05), while parameters irrelevant to liver function showed no significant difference (all P>0.05), and in non-cirrhotic patients, the preoperative TBA level were significantly higher in cases with Knodell stage S4 than that in those with Knodell stage S1 to S3 (all P<0.05). The incidence of operative complications in patients with preoperative TBA level ≥10 μmol/L was significantly higher than in those with preoperative TBA level <10 μmol/L (P<0.05). Conclusion: Preoperative TBA level is a sensitive indicator for assessing liver function in HCC patients, and in those with preoperative TBA ≥10 μmol/L, uni-segmental or local hepatectomy should be considered.