Currently there is a trend towards a reduction in blood loss during extensive liver surgery in cancer patients. This is associated with the use of current blood-saving technologies. However, when there is a favorable trend, the mean blood loss during hepatic resections exceeds 2000 ml as usual. In this case, the potential use of terlipressin, a synthetic analogue of vasopressin that has vasoconstrictive and hemostatic effects, is of interest. Objective: to evaluate the efficiency and safety of using terlipressin to reduce blood loss during extensive resections of the liver for its primary injury and metastatic colorectal cancer. Subjects and methods. The patients (mean age, 55.75±11.21 years) who had undergone extensive surgery for liver cancer were randomized into 2 groups. Group T (terlipressin) included 30 patients who received an intravenous injection of terlipressin 30 minutes before surgery. Group C (comparison) consisted of 30 patients who had a placebo solution 30 minutes prior to surgery. The patients of both groups received standard preventive hemostatic therapy (sodium ethamsylate 500 mg and tranexamic acid 5 mg/kg 30 min preoperatively). Results. An analysis of intraoperative hemodynamic parameters revealed no serious abnormalities in Group T, but heart rate during laparotomy was significantly lower than that in group C (62±11.2 and 69±12.26 min–1, respectively; р<0.05). The mean blood loss was 648.75±841.67 ml in Group T and 1562.5±854.88 ml in Group C (p<0.05). In Group T, intraoperative urine output was 71±141 ml/h or lower than that in Group C (75.12±3.02 ml/h) (р<0.05), but postoperative urine output was equal in the patients of both groups. There were no significant differences between the groups in laboratory data, including those in hemostatic parameters. Conclusion. The administration of 1 mg of terlipressin 30 min before surgery contributes to a significant reduction in intraoperative blood loss during extensive surgery for liver cancer. Terlipressin is able to exert a slight effect on intraoperative hemodynamic parameters as a moderate deceleration in heart rate. The use of the drug does not change the speed of urination, while has no significant effect on laboratory indicators of blood and the hemostatic system.