PURPOSE: Cystic lesions of the liver are highly variable in respect to appearance and therapeutic approach. However, without cystectomy and hepatic resection, the patient is at risk for recurrent enlargement, infection, or progression of an unrecognized malignant neoplasm. The goal of this study was to discern the safest and most effective method, with special emphasis on a suitable therapeutic technique for various cystic lesions of the liver. METHODS: We reviwed the cystectomy and hepatic resection and outcome of patients with hepatic cysts from November, 1987 to April, 2000 at the Hanyang University Hospital. A retrospective study of 19 patients with various cystic lesions of the liver was performed. RESULTS: There were 8 simple cysts, 2 polycystic liver disease, 2 biliary cystadenoma, 4 biliary cystadenocarcinoma, 2 hydatid cysts, and 1 traumatic cyst. In examining the 6 cystectomies, 13 hepatic resections. (4 right lobectomies, 4 left lobectomies, 5 minor hepatic resections), there were no postoperative deaths in this series. Four patients (21.1%) developed operative complications. During the mean follow- up time of 78.2 months, symptomatic relief was complete and permanent in all of patients except the 1 biliary cystadenocarcinoma 1 of the 4 patients with biliary cystadenocarcinoma died of tumor recurrence (5.3%) approximately 27 months after hepatic resection. CONCLUSION: Cystectomy and hepatic resection is a more curative treatment for cystic lesions of the liver than other treatments. We recommend complete cystectomy and hepatic resection as the preferred therapy, particularly when the cyst is large, a malignancy cannot be ruled out, and a proper diagnosis is not confirmed.