A consecutive series of 134 hepatic resections for primary and metastatic cancer were analyzed to identify the risk factors for post-operative complications in patients with and without impaired liver reserve. Between January 1992 and January 2000 were performed 55 hepatectomies (41%--group 1) in 54 cirrhotic patients for hepatocarcinoma and 79 hepatic resections (59%--group 2) in 66 patients for primary hepatic malignancies or metastatic liver tumours in non cirrhotic liver. Among major postoperative complications bile leakage was recorded in 8 patients (6%) (6% with impaired liver reserve and 6% with normal reserve), hepatic failure in 8 patients (6%) (9% vs 4%; P = NS), ascites in 7 patients (5%) (11% vs 1%; P = 0.01), pneumonia in 4 patients (3%) (5% vs 1%; P = NS), intra-abdominal abscess in 2 patients (1%) (2% vs 1%; P = NS), postoperative haemorrhage in 2 patients (1%) (4% vs 0; P = NS), and gastrointestinal bleeding in 2 patients (1%) (4% vs 0; P = NS). There were 6 perioperative deaths (4%) (7% vs 2%; P = NS). The mean hospital stay was 21 +/- 10 days (range: 5-57) (24 +/- 10 vs 20 +/- 10; P = 0.02). Liver resection is a safe procedure even in cirrhotic patients providing they are well selected and there is minimal intraoperative blood loss.