Abstract: Objective The study was aimed to analyze the clinical implications of splenic management in patients with primary liver cancer underwent hepatectomy. Methods Clinical data of 140 patients with primary liver cancer with underlying liver cirrhosis and hypersplenia between January，2006 and January，2016 was retrospectively analyzed. 46 patients in group A received hepatectomy and splenectomy，34 in group B received hepatectomy and splenectomy and pericardia vascular disconnection，30 in group C received hepatectomy and ligation of splenic artery，and 30 in group D received hepatectomy alone. Results The general materials，operation time，intraoperative blood loss，intraoperative blood transfusion volume in four groups had no statistical difference （P>0.05）；two weeks after treatment，blood PLT and WBC counts in group C were[（215.4±118.9）×10⁹/L and （3.36±1.23）×10⁹/L，in group D were [（176.4±105.5）×10⁹/L and（2.36±1.21）×10⁹/L，much lower than those in group A [（366.8±118.7）×10⁹/L and（7.52±1.18）×10⁹/L]，or in group B [（372.6±119.8）×10⁹/L and （7.54±1.19）×10⁹/L，P<0.05]；serum TBIL，AST and ALT levels in group D were [（37.7±5.1） μmol/L，（65.8±8.2）U/L and （75.8±10.1） U/L，much higher than those in group A[（24.8±4.8） μmol/L，（44.7±10.9）U/L and （50.1±12.2）U/L]，or in group B [（25.5±5.0）μmol/L，（45.8±9.9）U/L and （51.3±12.8） U/L]，or in group C[（24.4±5.0）μmol/L，（45.3±9.5）U/L and（50.4±11.8） U/L，P<0.05]；the percentage of CD4+ cells and CD4+/CD8+ ratio in group D were [（28.3±5.9）% and （1.3±0.3）]，obviously lower than those in group A [（44.1±5.9）% and （2.0±0.2）]，or in group B [（43.5±6.8）% and （2.0±0.3）]，or in group C [（39.2±6.8）% and（1.9±0.2）]，and the percentage of CD8+ cells in group D was （30.3±7.8）%，obviously higher than those in group A（22.0±6.9）%，or in group B（22.4±6.5）%，or in group C（21.8±7.0）% （P<0.05）；the complication occurrence in group D was 33.3%，obviously higher than those in group A，B，C （17.4%，23.5%，20.0%，respectively）. Conclusion The proper management of spleen could significantly improve the immune function and liver function，and the life quality in patients with primary liver cancer.

Key words: Primary liver cancer, Hypersplenia, Hepatectomy, Splenectomy, Gastroesophgeal devasculation, Splenic artery ligation