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Major liver resections carry a significant mortality due to liver insufficiency in patients with liver cirrhosis. To increase safety of major liver resections we aimed to combine the regenerative potential of bone marrow derived stem cell application and the safety of a novel two stage procedure in a patient with centrally located hepatocellular cancer and Child B cirrhosis.A 76 year old male patient with a cryptogenic liver cirrhosis presented with a mass of 5 cm in Segments IV a/b. A biopsy showed a moderately differentiated (G2) hepatocellular carcinoma. Since a sufficient distance to the portal pedicle and the hepatic veins was suggested by preoperative imaging and no contraindication for an intentionally curative resection was seen, the patient was explored. In the operation the limits of the carcinoma were difficult to discern within the cirrhotic liver and a non-anatomic Segment IVa/b resection resulted in an R1 situation. The patient was not considered eligible for a formal central or left resection due to the advanced liver cirrhosis. He recovered from surgery without complications and left the hospital on pod 15 with persisting ascites. Postoperative staging was pT2b, pN1, L0,V0,Pn1 G2, cM0, R1. After further recovery, medical suppression of his ascites and extensive counselling of the patient it was decided to attempt a curative resection. To improve hepatic reserve an in-situ splitting of the left and right liver (in-situ left hemihepatectomy) leaving only the artery, the bile duct and the middle and left hepatic veins intact, was performed. This ischemic injury to the left liver was combined with conditioning of the intact right liver with autologous CD133+ bone marrow derived stem cells via the right portal vein. The patient tolerated this procedure well. However, the cirrhotic right liver did not increase in size. On pod 12 the left liver was removed. The patient developed a moderate hepatic insufficiency with bilirubin levels up to 4 g/dl and occasional need to substitute his coagulation factors. The patient did not develop renal insufficiency, encephalopathy or hepato-pulmonary syndrome and was discharged on pod 15 after the conditioning operation in excellent general condition. He is tumor-free at his first oncologic follow-up.This case suggests that optimizing conditioning of the future liver remnant can render patients eligible for formal liver resections that are otherwise only candidates for palliative treatment. Since an R0 resection is still the only potentially curative treatment, and liver transplants are an option for only a minority of patients, a combination of this innovative approach of a two stage liver resection with liver augmentation by CD133+ bone marrow derived stem cells may change perspectives for some cirrhotic patients with hepatocellular cancer.