BACKGROUND/AIMS Hepatic resection for hepatocellular carcinoma (HCC) is risky for cirrhotic patients with severe thrombocytopenia. METHODOLOGY Among 23 patients with histologically proven cirrhosis who underwent hepatic resection for HCC at our hospital since 2006, 7 had severe thrombocytopenia (platelet count <5×104/mm3). The clinical background and surgical outcomes of these 7 patients were retrospectively evaluated and compared to those of the 16 cirrhotic patients without severe thrombocytopenia. RESULTS All 7 patients had hepatitis C virus-related liver cirrhosis. The median preoperative platelet count was 4.3×104/mm3 (range, 3.9-4.9×104/mm3) and the median operative time and intraoperative bleeding were 77min and 193cc, respectively. Postoperative complications were observed in 4 patients (57%) and all were managed conservatively. Four patients received an intraoperative platelet-rich transfusion, but this had no beneficial effect on intraoperative bleeding or postoperative changes in platelet counts. The cirrhotic patients with severe thrombocytopenia were significantly younger and had a significantly shorter operative time compared to those without severe thrombocytopenia. There were no other differences between the groups. CONCLUSIONS Our results suggest that the indication for hepatectomy in cirrhotic patients should not be based on platelet counts alone. However, we note that the younger age and shorter operative time for the patients with severe thrombocytopenia might have contributed to the safety of hepatectomy.