Objective: The authors summarize the results of patients who had hepatectomy for hepatocellular carcinoma over a 22-year period. Summary Background Data: Recent reports showed improved perioperative results and long-term prognosis. Methods: The perioperative outcome of 343 patients was studied according to three different time periods: before 1987 (n = 149); 1987 to 1991 (n = 128); and 1992 to present (n = 66). Survival analysis was made by stratifying patients into two categories either before or after 1987. The majority of patients had large tumors (78%); cirrhosis (73%), and a major hepatectomy (73%). Results: Besides an increased resectability rate (23%), there was a marked reduction of the recent morbidity (32%; p < 0.001), operative (4.5%; NS) and hospital (6%; p < 0.02) mortality rates. The recent surgical approach was identified as a significant contributory factor to the lowered hospital mortality rate. Patients in the latter part of the study had significantly better survival, with a 1-, 3-and 5-year survival rate of 68%, 45%, and 35%, respectively. Early detection and effective treatment of recurrences contributed to the improved prognosis. Conclusions: The recent management strategy and technological advances improved the results of surgical treatment for patients with hepatocellular carcinoma.