Abstract: Objective To explore the feasibility of one-stage combined surgery for hepatocellular carcinoma (HCC) with portal hypertension (PHT). Methods A total of 56 patients with HCC and PHT underwent surgery were retrospectively analyzed. Thirty-seven cases only received splenectomy, and 19 cases received splenectomy, and pericardial blood vessel disarticulation. Fourty-two patients underwent partial hepatectomy, of which 2 cases combined with intraoperative radiofrequency ablation (RFA), 10 cases underwent regular left lateral hepatic resection and 4 cases received intraoperative RFA only. Results The surgery went smoothly with no death during the operation. The postoperative complications were 16 patients suffered from portal vein thrombosis (PVT), 1 patient experienced abdominal infection, 15 patients had pleural effusion, 9 patients had ascites, 1 patient had acute inflammatory response syndrom, 1 patient had difficulty in eating, 1 patient experienced abdominal mass oozing of blood, 3 patients suffered from wound infection and 2 patients suffered from pulmonary infection. There were 48 patients being followed up. And the liver funtion was improved significantly. Eight patients died within one year and the survival rate was 83.3% (40/48). During 3-year period, 20 patients died and the survival rate was 58.3% (28/48), of which 18 patients died of tumor recurrence or metastasis, 1 patient died of postoperative upper gastrointestinal hemorrhage and 1 patient had accidental death. Conclusion One-stage combined surgery doesn't increase the opeative mortality rate in the treatment of HCC with PHT, suggesting that it is a safe and feasible method.