Background: Pulmonary metastasis(PM) form hepatocellular carcinoma(HCC) is a major indicator of a poor prognosis after liver resection. The study aimed to probe into the influencing factors for PM following open liver resection(OLR) and laparoscopic liver resection(LLR) with HCC. Method: All patients who suffered from LLR and OLR for primary HCC, who developed pulmonary metastasis, as first extrahepatic metastasis, were retrospectively analyzed in our department from January 2014 to August 2020. Results: Thirty-three cases were included (median age 50 years,81.8% male). The patients with a single tumor had 23 cases (69.7%), and a total of 10 patients(30.3%) has two and more tumors. 21 cases (63.6%) were smaller than 10 cm of tumor diameter. The median of operation time was 200 minutes (110-360), Portal vein occlusion occurred in 12 patients(36.4%). Patients with intrahepatic recurrence received vertebroplasty combined chemotherapy(VPCC), targeted therapy , trans-arterial chemo-embolization(TACE) and radio frequency catheter ablation(RFCA) in 1(3%),1(3%),10(30.3%) and 7(12.1%) cases respectively. The 2- and 3- year cumulative probability of overall survival (OS) were 63% and 41%. The median OS was 30.8 months. The median recurrence time was 6 months(1.7-4.8). The median of confirmed PM time from HCC was 12.5 months(1.5-61.1) and 17(51.5%) patients died. Conclusion: Early detection of intrahepatic recurrence and treatment can prolong PM time and overall survival time.