Objective To investigate the impact of left lateral lobectomy and left hepatectomy on the prognosis of patients with hepatocellular carcinoma (HCC) located in the left lateral lobe. Methods A total of 278 patients with HCC located in the left lateral lobe who underwent left lateral lobectomy (n=223) or left hepatectomy (n=55) in our hospital from Jan. 2011 to Jan. 2013 were enrolled. All patients were followed up after operation. The overall survival (OS) and tumor recurrence (TR) curves of patients who underwent left lateral lobectomy or left hepatectomy were drawn and compared by Kaplan-Meier method. The prognostic factors were analyzed by univariate and multivariate Cox regression analyses. Results Multivariate Cox regression analysis showed that narrow margin (hazard ratio[HR]=1.427, 95% confidence interval[CI] 1.014-2.006, P=0.041; HR=1.441, 95% CI 1.062-1.955, P=0.019), microvascular invasion (MVI) positive (HR=1.598, 95% CI 1.137-2.246, P=0.007; HR=1.374, 95% CI 1.018-1.854, P=0.038), tumor size ≥ 5 cm (HR=1.691, 95% CI 1.188-2.408, P=0.004; HR=1.359, 95% CI 1.003-1.841, P=0.048) and multiple tumors (HR=1.855, 95% CI 1.211-2.840, P=0.005; HR=1.950, 95% CI 1.327-2.863, P=0.001) were independent risk factors for OS and TR. The 1-, 3- and 5-year OS rates of patients who underwent left lateral lobectomy and left hepatectomy were 89.7%, 64.5%, 45.5% and 90.9%, 72.7%, 52.2%, respectively (P=0.329), and the 1-, 3- and 5-year TR rates were 18.4%, 53.4%, 71.5% and 14.5%, 41.8%, 62.1%, respectively (P=0.146). The 1-, 3- and 5-year OS rates of patients who underwent left lateral lobectomy and left hepatectomy with wide margin were 92.3%, 71.5%, 53.1% and 90.9%, 72.7%, 52.2%, respectively (P=0.965), and the 1-, 3- and 5-year TR rates were 13.8%, 45.4%, 67.1% and 14.5%, 41.8%, 62.1%, respectively (P=0.605). The 1-, 3- and 5-year OS rates of patients who underwent left lateral lobectomy and left hepatectomy with narrow margin were 86.0%, 54.8%, 34.9% and 90.9%, 72.7%, 52.2%, respectively (P=0.036), and the 1-, 3- and 5-year TR rates were 24.7%, 64.5%, 77.7% and 14.5%, 41.8%, 62.1%, respectively (P=0.013). The overall postoperative complications and grade Ⅲ/Ⅳ complications between the left lateral lobectomy and left hepatectomy were 16.1% (36/223) vs 20.0% (11/55) and 1.8% (4/223) vs 3.6% (2/55), respectively (both P>0.05). Conclusion Surgical method is not an independent risk factor for the prognosis of patients with HCC located in the left lateral lobe. However, if the tumor is close to the sagittal part and a wide margin cannot be ensured during left lateral lobectomy, left hepatectomy is recommended.