Impact of Middle Hepatic Vein Resection During Hemihepatectomy on Surgical Outcomes and Long-Term Prognosis in Hepatocellular Carcinoma: A Retrospective Study

Abstract

Purpose: This study aimed to evaluate the impact of middle hepatic vein (MHV) resection during hemihepatectomy on short-term surgical outcomes and long-term prognosis in patients with hepatocellular carcinoma (HCC). Patients and Methods: Patients with HCC at Barcelona Clinic Liver Cancer (BCLC) stages 0-B who underwent hemihepatectomy between January 2016 and December 2022 were retrospectively screened. They were categorized into the MHV-preserved and MHV-resected groups. Intraoperative parameters, postoperative complications, liver function, overall survival (OS), and recurrence-free survival (RFS) were compared. Cox regression analyses were used to identified independent risk factors for OS and RFS. Results: A total of 137 patients were included, of whom 107 (78.1%) had MHV preserved and 30 (21.9%) had MHV resected. Compared with MHV preservation, MHV resection was associated with a longer operative time (329.9 ± 108.0 vs 291.4 ± 88.9 min, P = 0.048), greater intraoperative blood loss (1025.0 [400.0– 2075.0] vs 500.0 [300.0– 800.0] mL, P = 0.002), and a higher need for intraoperative blood transfusion (43.3% vs 24.3%, P = 0.041). Postoperative serum ALT and AST levels on days 3 and 5 were significantly higher in the MHV-resected group (all P < 0.05). However, postoperative hospital stay, complication rates, and other liver function parameters (ALB, TBIL, DBIL, PT, INR) did not differ significantly between the two groups. No significant differences were found in OS or RFS (all P > 0.05). Conclusion: MHV resection during hemihepatectomy increases operative time, blood loss, and postoperative liver enzyme levels, but does not significantly impact long-term survival in patients with HCC. Keywords: liver cancer, liver function, liver resection, hepatic vein, survival