Key Words: Hepatocellular carcinoma; Platelet count; Surgical outcome; Prognostic factors. Abbreviations: Hepatocellular carcinoma (HCC); Low Platelt Count (LPC); Indocyanine Green Retention Rate at 15 min (ICGR15); Total Bilirubin (T-Bil); Albumin (ALB); Prothrombin Time (PT); Alkaline Phosphatase (ALP); Esophagogastric Varices (EV); Tumor invasion to the main branch or trunk of portal vein (Vp3, 4); α-fetoprotein (AFP); Transcatheter Arterial Chemoembolization (TACE); Surgical Margin (SM). Background/Aims: Hepatocellular carcinoma (HCC) patients often have low platelet count (LPC). The aim of this study was to determine unique features of HCC patients with LPC. Methodology: HCC patients who underwent surgery were divided into two groups: LPC group (platelet count ?100,000/mm3, n=84) and control group (platelet count >100,000/mm3, n=240). Surgical outcomes, risk factors for postoperative complications and prognostic factors were retrospectively compared. Results: HCC patients with LPC had poorer liver function, smaller tumors, less anatomical resection and more frequent postoperative liver failure than control group patients. Postoperative survival was not different between the two groups. Tumor invasion to the main branch or trunk of portal vein (Vp3, 4) was the only risk factor for postoperative substantial complications in the LPC group. Postoperative survival was worse in patients with tumor diameter ?4cm or multiple tumors and in those who underwent preoperative transcatheter arterial chemoembolization (TACE) in the LPC group by multivariate analysis. Among them, preoperative TACE were not prognostic factors in the control group. Conclusions: In HCC patients with LPC, Vp3, 4 patients should be carefully monitored after surgery and preoperative TACE is not recommended for long-term postoperative survival.