Objective: To assess the value of ASA score in risk estimation for liver cancer patients undergoing surgical treatment. Methods: The perioperative clinical data of 419 patients undergoing hepatectomy for primary liver cancer from January 2006 to December 2010 were reviewed. The relationship between ASA score and clinical factors of the patients was analyzed, and the factors associated with postoperative complications and intraoperative blood transfusion were determined by multivariate regression analysis after univariate analysis screen for the possible related factors. Results: Statistical analysis showed that ASA score was affected by preoperative complications and hemoglobin content in liver cancer patients, and the intraoperative blood loss, blood transfusion volume, postoperative complications, and length of postoperative hospital stay was increased with ASA score increase (all P<0.05). Multivariate regression analysis identified that ASA score, intraoperative blood loss, liver cirrhosis, age, and alanine aminotransferase (ALT) level were independent factors for the occurrence of postoperative complications (all P<0.05), and ASA score, operative time, and tumor diameter were independent factors for intraoperative blood transfusion (all P<0.05). Conclusion: ASA score is a better index for early estimation of the perioperative risk of liver cancer patients undergoing hepatectomy.