Objective To study the operative techniques and the surgical results of hepatic alveolar echinococcosis. Methods Forty three patients with hepatic alveolar echinococcosis treated in our Hospital from 2000 to 2008 were studied retrospectively. They were divided into two groups: radical resection group (19 cases) and palliative resection group (24 cases). Results There were 1 surgeryrelated death, 2 patients with remote metastases, 2 patients with intrahepatic dissemination, 4 patients with recurrent jaundice and 3 patients with cholangitis in the palliative resection group. There were 3 patients with biliary fistula, 1 patient with cholangitis and 3 patients with emaciation in the radical resection group. Among the 30 patients followed-up for ≤3-≤8 years, 10 patients died in the palliative resection group and the long-term survival rate was 28.5% (4/14). One patient died from gastric cancer in the cardiac in the radical resection group and the long survival rate was 93. 7%(15/16). Conclusions The first choice of treatment for hepatic alveolar echinococcosis is radical resection. Patients could be cured by radical resection. Palliative surgery is an option for patients not manageable otherwise.