OBJECTIVES: the impact of handgrip strength (HGS) on postoperative complications and long-term survival following hepatectomy in patients with primary liver cancer (PLC) remains unclear. This study aimed to evaluate the influence of HGS on postoperative complications and overall survival in patients with PLC. METHODS: in total, 298 patients with PLC who underwent liver resection were included in the prospective cohort study. Baseline, surgical, and histopathological factors were analyzed using univariate and multivariate analyses to identify risk factors for postoperative complications and mortality. RESULTS: the incidence of major postoperative complications was 40.3 % and 24.6 % in the low and high HGS groups, respectively. During the median follow-up period of 28.8 months, 57 patients (19.1 %) died. patients with low HGS demonstrated a significantly shorter median overall survival compared to those with high HGS (p <
0.001). Short-term analysis revealed that low HGS (p = 0.022) and intraoperative blood loss (≥ 200 ml) (p <
0.001) were independently associated with postoperative complications. Furthermore, low HGS was identified as an independent predictor of poor overall survival in long-term survival analysis (p = 0.005). CONCLUSIONS: preoperative HGS emerged as an independent factor for postoperative complications and a prognostic indicator of poor long-term outcomes in patients with PLC.