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Surgery is one of the most effective treatment modalities for hepatocellular carcinoma (HCC). However, surgery is stressful and it is not clear whether surgery is suitable for elderly HCC patients. This issue is becoming increasingly important as the number of elderly HCC patients rises. Adequacy of surgery for elderly HCC patients has been discussed in 18 reviewed reports that retrospectively compared surgical outcomes between elderly and younger patient groups. Although deterioration of liver function and that of other organs is greater in the elderly than in younger patients, many reports demonstrated no difference between groups. We review, interpret and summarize the published reports that address surgery for elderly HCC patients as well as disclose contemporary surgical strategy and discuss issues requiring further investigation.