Hepatocellular carcinoma (HCC) is a significant health concern, and the complexity of liver anatomy poses challenges in conveying radiologic findings and surgical plans to patients. This study aimed to evaluate the impact of a virtual reality (VR) education program on anxiety and knowledge in HCC patients undergoing hepatic resection. From January 1, 2022, to February 28, 2023, 88 patients were enrolled in a randomized controlled trial, divided into the VR group (n=44) and the control group (n=44). The VR group received patient-specific 3D liver model education through a VR platform, while the control group underwent conventional explanation processes. Both groups completed pre- and post-intervention questionnaires assessing anxiety (using STAI-X-1, STAI-X-2, and VAS) and knowledge about liver resection. Comparison of the questionnaires were performed between the two groups. Multivariable logistic regression was performed to analyze factor related to decrease in anxiety. While there was no significant difference in pre-intervention anxiety and knowledge scores between the two groups, the VR group exhibited significant reduction in STAI-X-1 scores (-4.14±7.5) compared to the control group (-0.84±5.7, P=0.023), as well as knowledge scores (17.20±2.6) compared to the control group (13.42±3.3, P < 0.001). In the multivariable logistic regression model, VR education showed significant impact on decrease in STAI-X-1 score, post-intervention. (OR=2.902, CI=1.097-7.674, P=0.032). The VR education program significantly improved knowledge and reduced anxiety among HCC patients compared to conventional methods. This study suggests that VR can be a valuable tool in patient education, enhancing comprehension and alleviating pre-surgical anxiety.