To compare the clinical efficacy of laparoscopic anatomical left hepatectomy via anterior approach versus tunnel approach for hepatocellular carcinoma (HCC).

A total of 114 patients with HCC who underwent laparoscopic anatomical left hepatectomy from December 2019 to December 2024 were retrospectively enrolled. The patients were divided into the anterior approach group (n=57) and the tunnel approach group (n=57) according to surgical access. Perioperative parameters, liver function indices and inflammatory factors were compared using the t test or χ² test. The 12-month postoperative disease-free survival curves were plotted by the Kaplan-Meier method, and the Log-Rank test was performed for intergroup comparison.

The tunnel approach group had less intraoperative blood loss, as well as shorter hepatic portal occlusion time, gastrointestinal function recovery time, drainage tube removal time and hospital stay than the anterior approach group (P<0.05). Compared with preoperative levels, alanine transaminase (ALT) and aspartate transaminase (AST) were elevated on postoperative day 3 and day 7 in both groups; these two indicators decreased on postoperative day 7 relative to day 3, and were significantly lower in the tunnel approach group (P<0.05). Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) increased on postoperative day 3 and decreased on postoperative day 7 in both groups, with lower levels observed in the tunnel approach group (P<0.05). There were no significant differences in the overall incidence of postoperative complications and 12-month disease-free survival between the two groups (P>0.05).

Compared with laparoscopic anatomical left hepatectomy via the anterior approach, the tunnel approach can reduce intraoperative blood loss and hepatic portal occlusion time, accelerate the recovery of gastrointestinal function, drainage tube removal and hospital discharge. It also alleviates surgical damage to liver function and postoperative inflammatory response with favorable safety, and facilitates short-term postoperative recovery of HCC patients.