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Background: Despite recent advanced surgical technique with newly developed hemostatic devices, hepatectomy remains one of the most hemorrhagic procedures in abdominal surgery. To reduce the need for homologous blood transfusion, it is important to clarify the preoperative predictors influencing intraoperative blood loss during hepatectomy and the need for autologous blood storage.Methods: From September 2007 to August 2009, 216 consecutive patients underwent elective hepatectomy for tumor. Hepatectomy was performed for hepatocellular carcinomas (n=87), mass-forming cholangiocellular carcinomas (n=19), hepatic metastases (n=104), and other tumors (n=6). Hepatectomy was performed under intermittent occlusion of inflow vessels (15 minutes) with clamp crushing method. Minor hepatectomy was defined as limited resection or resection of less than two Couinaud’s segments, and major hepatectomy consisted of resection of more than two or more Couinaud’s segments. Intraoperative blood loss of more than 1500 ml was defined as massive blood loss, which might potentially need autologous blood storage. Results: There was no in-hospital mortality, but morbidity occurred in 65 patients (30.1 %). The mean and median blood loss was 842 ± 771 ml and 621ml (range: 10-4443), respectively. Major hepatectomy was performed in 92 patients (42.6%) and minor hepatectomy in 124 patients (57.4%). Thirty five patients or 16% of all the patients experienced intraoperative blood loss of more than 1500ml. During operation, 16 patients (7%) received red cell blood transfusion. Two patients (0.9%) were returned to the operating room for postoperative hemorrhage.Univariate analysis identified body mass index (BMI, p=0.001), tumor size (p=0.002), resected liver volume (p<0.001), serum total bilirubin (p¬=0.053), serum prothrombin time (p=0.044), serum glutamate pyruvate transaminase (p=0.041), major hepatectomy (p<0.001), wide incision with right thoracotomy (p=0.085), and additional operative procedure (p=0.034) as risk factors for massive intraoperative blood loss; multivariate analysis identified major hepatectomy (p<0.001) and BMI (p=0.005) as independent risk factors of blood loss of more than 1500 ml. Conclusions: Autologous blood storage might be indicated in patients with these predictive factors. Laparoscopic hepatectomy should not be considered in these patients, because of increased intraoperative blood loss.