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Background. Estimation of functional liver reserve in patients with hepatocellular carcinoma (HCC) is of paramount importance to properly select candidates for surgical resection. Together with the value of bilirubin, the presence/absence of ascites and esophageal varices, and the rate of residual liver volume, which are our current parameters to measure functional liver reserve, we sought to investigate the value of preoperative cholinesterases (CHE) in predicting postoperative adverse outcomes after hepatic resection for HCC.Methods. We reviewed the records of 181 consecutive patients who underwent hepatic resection for HCC in our Unit between 2001-2009. The value of preoperative CHE was analyzed against the occurrence of postoperative adverse events. Receiver-operator characteristic curve analysis was used to identify cut-off values of CHE that predicted adverse outcomes. Univariate and multivariate analyses on clinically relevant variables were performed. P<0.05 was considered statistically significant. Results. Forty-nine (27%) of 181 patients had complications, of which 36 (20%) were liver-related. Major morbidity occurred in 11 (6%) patients. The 30-day postoperative mortality was 1% (2 patients). A value of CHE≤5,900 UI/L had a sensitivity of 73% and a specificity of 67% in predicting liver-related postoperative complications (P=0.001). The multivariate analysis revealed that blood transfusion, major resections, and a value of CHE≤5,900 UI/L independently predicted the risk of morbidity. Conclusions. The value of CHE contributed important information in predicting postoperative adverse outcomes after hepatic resection for HCC. Thus, it should be included in the selection process of candidates to surgery for such disease. [ClinicalTrials.gov ID=NCT00883454]