Abstract: Objective To analysis the risk factors of massive ascites after anatomical hepatectomy for primary hepatocellular carcinoma. Methods A total of 80 primary hepatocellular carcinoma patients who were treated in Department of Hepatopancreatobiliary Surgery, the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2022 were selected and their clinical data were retrospectively analyzed. All patients performed anatomical hepatectomy and divided into two groups according to postoperative abdominal fluid drainage: a massive ascites group and a non-massive ascites group. The risk factors of massive ascites in primary hepatocellular carcinoma patients after anatomical hepatectomy were analyzed by univariate and multivariate logistic analyses. Results Among the 80 patients, there were 18 cases (22.5%) of massive ascites after anatomical hepatectomy. According to univariate analysis, postoperative massive ascites was related to prealbumin level, alkaline phosphatase level, prothrombin time activity, preoperative portal hypertension, indocyanine green retention rate at 15 min (ICGR15), standardized residual liver volume and intraoperative blood loss (P<0.05). Multivariate logistic analysis indicated that low prealbumin level, low prothrombin time activity, preoperative portal hypertension and ICGR15 >15% were the independent risk factors of massive ascites after anatomical hepatectomy for primary hepatocellular carcinoma (P<0.05). Conclusions Low prealbumin level, low prothrombin time activity, preoperative portal hypertension and ICGR15 >15% are the independent risk factors of massive ascites after anatomical hepatectomy for primary hepatocellular carcinoma.