The peak incidence of primary liver cancer is between 30 and 60 years of age, but with the increase in average life expectancy and advances in detection, the incidence of hepatocellular carcinoma in the elderly has increased, and the peak age-specific mortality rate has shifted to the 60- to 69-year-old group. However, because of the generally poor organ reserve function of elderly patients and the frequent complications of various underlying diseases, the tolerability of surgery is seriously affected and the perioperative mortality rate is still high. Strictly grasping the indications for hepatocellular carcinoma surgery in the elderly, attaching importance to surgical techniques and strengthening perioperative management are the key issues to improve the survival rate of hepatocellular carcinoma in the elderly. 1.Strictly grasp the indications for liver cancer surgery in the elderly The physiological functions of various organs in the elderly organism are decreasing, and the complication rate and perioperative mortality rate of liver cancer surgery in the elderly are higher. We have observed that the incidence of two serious complications, namely liver failure and respiratory and circulatory failure due to severe pulmonary infection, are significantly higher in the elderly, which is also the main reason for the higher perioperative mortality rate in the elderly group. Our experience in grasping the indications for surgery for hepatocellular carcinoma in the elderly is: (1) patients with severe cardiac or renal dysfunction or those with liver function grade Child B or C should be contraindicated; (2) pulmonary infection should be actively controlled before considering surgery, and those with uncontrolled or chronic disease combined with severe pulmonary ventilation impairment should be contraindicated. If larger surgery such as hemihepatectomy is performed, the surgical indications should be grasped more strictly and the preoperative preparation should be more adequate. The amount of hepatic resection, the amount of intraoperative bleeding and the time of hepatic portal block are directly related to the recovery of postoperative liver function. Elderly patients with hepatocellular carcinoma often have reduced regenerative capacity of the liver, and regular hepatic resection is a risky operation, therefore, we do not advocate forcing regular hepatic resection for those whose general condition and liver function are not satisfactory. The operation should be performed gently, quickly and accurately to shorten the operation time and minimize bleeding. Some scholars believe that hilar block is not conducive to the recovery of liver function after surgery, and advocate that hilar block should not be used for elderly patients. Therefore, we believe that the technique of hemiflow block is feasible in hepatocellular carcinoma surgery for the elderly, but the blocking time should be strictly controlled, and it is safe to use less than 20 min, and those who have the conditions should try to use hemiflow blocking technique, which can effectively control bleeding and minimize the impact on liver function. The older the elderly patient is, the lower the immune function, liver regeneration ability and tissue healing ability of the body, and the higher the postoperative complication rate, so the perioperative treatment should be more careful and strict than that of younger patients. 4. Preoperative management In addition to routine check of liver and kidney function, coagulation function, blood sugar, chest X-ray and electrocardiogram, we also performed pulmonary function check for elderly patients to further estimate the risk level of surgery. Factors that may increase the risk of surgery, such as hypertension, hyperglycemia and hypoproteinemia, were corrected as much as possible before surgery, and short-term liver protection and intravenous high nutrition support were given. 5, intraoperative anesthesia management Most of the surgical procedures take general anesthesia with epidural block anesthesia, which can minimize the intervention on the internal environment of the body, especially the amount of intraoperative drugs can be reduced to reduce the detoxification burden of the liver, which is conducive to the rapid recovery of postoperative liver function and can reduce postoperative respiratory complications [6]. Postoperative management and active prevention of complications (1) Infection: elderly patients are prone to postoperative pulmonary complications, and pulmonary infection is an important factor of postoperative death in elderly patients with hepatocellular carcinoma [7], therefore, we should pay great attention to the prevention and treatment of pulmonary infection. (2) Post-operative bleeding: In the case of severe post-operative bleeding, early correction of coagulation disorders should be emphasized, and early transfusion of fresh plasma, platelets and cold precipitation should be given according to the coagulation function test; (3) Liver failure and hepatorenal syndrome: active liver protection treatment should be given, attention should be paid to the supplementation of albumin, and renal perfusion should be ensured. (3) liver failure and hepatorenal syndrome: active liver protection treatment should be given, attention should be paid to albumin supplementation, ensuring renal perfusion, and avoiding drugs that are detrimental to liver and kidney function. In addition, effective postoperative control of blood pressure, blood glucose and other comorbidities as well as nutritional support should not be neglected. In the treatment of hepatocellular carcinoma in the elderly, we can still achieve satisfactory results in the surgical treatment of primary hepatocellular carcinoma in the elderly as long as we emphasize adequate perioperative preparation, focus on surgical techniques, and strengthen postoperative complication prevention and management.