Abstract: Objective To compare the clinical efficacy of open anatomical hepatectomy using different approaches for the treatment of hepatocellular carcinoma (HCC). Methods This study was a prospective randomized controlled study. Sixty-four patients with HCC admitted to the hospital from January 2020 to January 2023 were included. According to the random number table method, the patients were divided into a control group (n=32 cases, the patients received conventional approach for open anatomical hepatectomy) and an observation group (n=32 cases, the patients received open anatomical hepatectomy along with the main hepatic vein approach). The peri-operative related indexes, liver function indexes, immune function indexes and inflammatory factors levels before and 7 days after operation were compared between the two groups, and the postoperative complications of the two groups were counted. Results The intra-operative blood loss in the control group was (324.44±76.73)mL, which was statistically significant different with that of (250.27±68.64)mL in the observation group (t=4.075, P<0.05). At 7 days after operation, the levels of aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase and total bilirubin in the control group[(73.33±8.23)U/L, (94.44±9.19)U/L, (84.61±8.53)U/L and (24.39±2.64)μmol/L respectively] were higher than those in the observation group [(64.52±7.46)U/L, (94.44±9.19)U/L, (73.36±9.58)U/L and (22.14±2.96)μmol/L respectively,P<0.05] . Three days after operation, the levels of IgA, IgG and IgM in the control group (1.71±0.23, 8.31±1.53 and 1.21±0.28, respectively) were lower than those in the observation group (1.95±0.24, 9.39±1.75 and 1.35±0.32, respectively, P<0.05). Three days after operation, the levels of serum interleukin-6, tumor necrosis factor-α, and C-reactive protein in the control group [(149.89±30.79)ng/L, (229.15±27.24)ng/L and (28.74±3.26)mg/L respectively] were higher than those in the observation group [(128.85±20.81)ng/L, (208.11±23.26)ng/L and(22.21±3.44)mg/L respectively, P<0.05]. The total incidence of postoperative complications in the control group was 21.88% (7/32), while that in the observation group was 15.63% (5/32), without statistical significant difference (χ²=0.410, P=0.522). Conclusion Compared with conventional approaches, the use of a main hepatic vein approach in patients with HCC can alleviate the liver damage and immune dysfunction caused by open anatomical hepatectomy, thus has a higher safety.

Key words: Main hepatic vein approach, Anatomical hepatectomy, Hepatocellular carcinoma