Effect of Laparoscopic Hepatectomy Combined With Splenectomy on Hepatic Functional Reserve and Immune Function

This is a single-center, prospective, observational cohort study. The primary outcome is hepatic functional reserve（ICG-R15） at 12 and 24 months post-surgery. Secondary outcomes include peripheral blood lymphocyte subsets（CD4^+ T, CD8^+ T, Treg, NK cells）, serum cytokines, and HCC recurrence rates at 12 and 24 months（confirmed by contrast-enhanced CT/MRI）. All participants will undergo scheduled follow-up visits at 3, 6, 12, 18, and 24 months post-surgery. Written informed consent will be obtained from all participants before surgery. The study protocol has been approved by the Institutional Ethics Committee.

Inclusion criteria

• Age 18-80 years, both male and female.
• Hepatocellular carcinoma (HCC) confirmed by clinical, pathological, and radiological examinations, meeting either of the following criteria:Solitary tumor with maximum diameter ≤ 5 cm; or Multiple tumors (≤ 3 in number), each with maximum diameter ≤ 3 cm.
• Liver cirrhosis with splenomegaly and hypersplenism, and preoperative platelet count (Plt) < 80 × 10⁹/L.
• Liver function Child-Pugh class A or B, with ICG-R15 test indicating tolerance for the planned surgical resection.
• Voluntarily sign written informed consent.
• Able to complete 24-month follow-up.

Exclusion criteria

• Imaging evidence of extrahepatic metastasis or major vascular invasion (portal vein, hepatic vein); or concurrent other malignancy within the past 5 years.
• End-stage liver cirrhosis (Child-Pugh class C).
• Prior history of hepatectomy or splenectomy; or prior other abdominal surgery that precludes safe performance of laparoscopic hepatectomy combined with splenectomy.
• Cirrhosis-related complications (hepatic encephalopathy, refractory ascites) occurring within 1 month before surgery.
• Severe cardiac, pulmonary, or cerebrovascular dysfunction.
• Active infection or underlying disease requiring immunosuppressive therapy.
• Pregnancy or lactation.
• Poor compliance, unable to complete the scheduled follow-up