To compare the efficacy and safety of the anterior approach with hepatic suspension versus the traditional approach in right hepatectomy for primary hepatocellular carcinoma.

A retrospective analysis was performed on the clinical data of 93 patients with primary hepatocellular carcinoma who underwent right hepatectomy from February 2021 to February 2024. After propensity score matching, 84 patients were finally included. They were divided into the traditional approach group (treated with the traditional approach) and the anterior approach group (treated with the anterior approach with hepatic suspension) according to the surgical approach, with 42 patients in each group. Statistical analysis was performed using SPSS 26.0 software. Measurement data conforming to normal distribution were expressed as (±s), and independent sample t test was used for comparison between groups. Count data were expressed as rates (%), and the χ² test was used for comparison of rates between groups. Kaplan-Meier survival curves were plotted, and the Log-Rank test was used to analyze survival outcomes. A P value < 0.05 was considered statistically significant.

Compared with the traditional approach group, the anterior approach group had shorter operation time and hospital stay, less intraoperative blood loss, and a lower intraoperative transfusion rate (P<0.05). At 7 days after surgery, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) in both groups were higher than those before surgery, but the levels in the anterior approach group were lower than those in the traditional approach group (P<0.05). At 7 days after surgery, the serum levels of tumor necrosis factor-α (TNF-α), interleukin-6, and C-reactive protein (CRP) in both groups were higher than those before surgery, but the levels in the anterior approach group were lower than those in the traditional approach group (P<0.05). There was no statistically significant difference in the total incidence of postoperative complications between the two groups (P>0.05). At 1 year after surgery, the cumulative disease-free survival rate in the traditional approach group was lower than that in the anterior approach group (P<0.05). There was no statistically significant difference in the overall survival rate between the traditional approach group and the anterior approach group (P>0.05).

Compared with the traditional approach, right hepatectomy via the anterior approach with hepatic suspension can significantly shorten the operation time and hospital stay, reduce intraoperative blood loss and transfusion requirements in patients with primary hepatocellular carcinoma, and also help alleviate postoperative inflammatory responses and liver function damage.