Objective The aim of the study was to evaluate the long-term efficacy and safety of percutaneousmicrowave ablation (MWA) for small hepatic cancers adjacent to large vessels and to investigate thetreatment strategies.Methods From March 2009 to July 2015, a total of 86 patients with 94 tumors underwent ultrasound(US)-guided percutaneous MWA, with pathologically proven or clinically diagnosed liver cancers measuring≤ 3 cm in diameter and located ≤ 10 mm from a major vessel (n = 94). Regular follow-up after MWA wasperformed to assess treatment efficacy and perioperative complications.Results The complete ablation rate at 1 month after MWA was 93.3% (84/90). The 6-, 9-, 12-, 24-, 36-,48-, 60-, 72-, and 84-month local recurrence rates were 2.4%, 2.4%, 3.7%, 6.6%, 8.4%, 8.4%, 8.4%, 8.4%,and 8.4%, respectively. There were no major complications. The perioperative special complication ratewas 5.32% (5/94), including 3 cases of moderate liver function damage and 2 cases of limited sub-capsularhematoma.Conclusion Percutaneous MWA for small hepatic cancers adjacent to large vessels is feasible, effective,and safe with an acceptable rate of complications. The key point is to strictly follow operative indicationsand adopt proper treatment strategies.