Background: The aim of this retrospective study was to determine the impact of postoperative complications on the long‐term outcome of curative liver resection for hepatocellular carcinoma (HCC). Methods: A total of 863 patients who had curative resection of HCC from December 1989 to December 2004 were included in the analysis. Median follow‐up was 35·6 months. Results: Some 288 patients (33·4 per cent) developed postoperative complications. The hospital mortality rate was 5·3 per cent (46 patients). Multiple logistic regression analysis showed that older age and massive intraoperative blood loss were related to a significantly higher complication rate. Demographics of patients with and without postoperative complications were comparable. The former had significantly more blood loss (median 1·1 versus 0·7 litres; P < 0·001) and required more transfused blood (P < 0·001). The overall survival rates of patients without complications at 1, 3, 5 and 10 years were 83·6, 62·8, 51·5 and 32·1 per cent respectively. Corresponding rates for those with complications were 67·8, 52·4, 41·5 and 26·6 per cent (P = 0·004). Cox proportional hazard model analysis revealed that the presence of postoperative complications was independently associated with poor overall survival. Conclusion: Postoperative complications can affect overall long‐term survival after resection of HCC. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Complications alter survival