Objective To compare the perioperative outcomes of laparoscopic hepatectomy ( LH) versus open hepatectomy ( OH) for liver cancer patients with cirrhosis. Methods From September 2010 to June 2012, 78 liver cancer patients with cirrhosis hospitalized in Renmin Hospital affiliated to Wuhan University were considered for liver resection; among them, 32 patients were treated with LH, and 46 patients with OH. Intraoperative and postoperative conditions and tumor recurrence were compared between the two groups. Group t- test and paired t- test were used for measurement data, while chi- square test for enumeration data. Results The comparison of two groups indicated that the following indicators were significantly lower in the LH group than in the OH group: intraoperative blood loss ( t = 0. 057, P = 0. 040) , incidence of postoperative complications ( electrolyte imbalance, bile leakage, and ascites: t = 3. 001, 3. 241, and 4. 255, respectively, P< 0. 05 for all) , liver function on the first day after operation ( AST and ALT: t = 3. 427 and 3. 201, P = 0. 001 and 0. 002) , postoperative time to oral intake ( t = 3. 012, P = 0. 001) , length of hospital stay ( t = 2. 157, P = 0. 003) , and tumor recurrence ( t = 2. 751, P =0. 006) ; whereas, the operative time in LH group was significantly longer than that in OH group ( t = 3. 101, P = 0. 003) . Conclusion Compared with OH, LH has various advantages in liver cancer patients with cirrhosis, such as smaller abdominal incision, less intraoperative blood loss, lower incidence of postoperative ascites, decreased postoperative complications, shorter hospital stay, and lower incidence of tumor recurrence.