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Title: Health related outcomes following major hepatic surgery Introduction: Liver resection for hepatobiliary malignancies and liver transplantation for acute liver failure are major surgical procedures with good survival rates. Quality of life assessment is as important an indicator of treatment efficacy as survival and mortality. There are no long term prospective longitudinal studies using a validated quality of life instrument assessing quality of life after liver resections· for malignancies. Auxiliary transplantation for acute liver failure has not achieved its expected targets of liver regeneration and a patient free from immunosuppression. Nor are there any quality of life studies comparing auxiliary and orthotopic liver transplantation for acute liver failure. Materials and methods: Patients undergoing liver resections for primary or secondary liver tumours in a 1 year period from July 2002 were enrolled. They were asked to complete the generic questionnaire, European Organization for Research and Treatment of Cancer QlQ C30, pre operatively, 6 months, 1 year and 36-48 months post operatively. Survival and the quality of life with relation to several factors were analysed. All patients who were alive after liver transplantation for paracetamol induced acute liver failure since 1998 were contacted and asked to complete the Short Form 36 questionnaire. Survival, pre and perioperative factors and quality of life was compared between the two groups. Results: Liver resection: 103 patients were enrolled in this study. Patient compliance at each stage was 99,97,97 and 75 % respectively. After an initial deterioration at 6months patients showed a return to baseline levels at 36-48 months in all aspects of quality of life except for some symptom scales. Cholangiocarcinoma patients had the worst preoperative quality of life and showed the best improvement. Preoperative physical functioning had some bearing on survival. Those patients who remained recurrence free at 36-48 months had a better quality of life than at baseline. Liver transplantation: 13 patients underwent an auxiliary transplant for paracetamol overdose from 1998. There were 4 postoperative deaths and 1 re transplant. 5 year survival rate is 69%. The re transplantation free survival is 61 %. 7 of the remaining 8 patients are off immunosuppression with full liver regeneration. The quality of life of auxiliary transplant patients is higher in all domains compared to orthotopic transplant patients. Conclusion: Major liver resections and auxiliary transplantation are associated with acceptable outcomes in terms of survival and quality of life. Along with improving survival, liver surgery for hepatobiliary cancers can improve the quality of life of those who have recurrence free survival. Longer term quality of life studies with larger groups of patients and cost effectiveness studies are required.