Although hepatocellular carcinoma (HCC) is most often a sequela of severe hepatic fibrosis or cirrhosis, a proportion of cases arise in the noncirrhotic patient. The gold standard therapy in such cases is surgical resection. Innovations in operative technique allow for this treatment to be implemented with very low mortality and acceptable morbidity at high-volume hepatobiliary centers. This chapter discusses various etiologies of noncirrhotic HCC and presents a large single-center experience that is compared to other Western series.