Abstract: Objective To investigate the occurrence of symptoms in patients with　intermediate and advanced hepatocellular carcinoma after hepatectomy, to construct a symptom network for these patients, identify symptom clusters and core symptoms, and provide a basis for formulating targeted symptom management strategies. Methods A total of 299 patients with　intermediate and advanced hepatocellular carcinoma who underwent hepatectomy in department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital from September 2019 to December 2021 were selected by a convenience sampling method. A cross⁃sectional study was conducted using general demographic questionnaires, the Chinese version of the M.D. Anderson Symptom Inventory, The Symptom Module Specific to Primary Liver Cancer, and the Hospital Anxiety and Depression Scale. Symptom clusters were extracted by exploratory factor analysis , symptom cluster networks were constructed with R Programming Language, and core symptoms and symptom clusters were identified by analyzing the centrality indicators of the networks, including strength, tightness and mediation. Results The top 5 symptoms in patients with　intermediate and advanced hepatocellular carcinoma after surgery were dry mouth (89.30%), abdominal distension (86.29%), pain (80.26%), fatigue (79.26%), and sleep disturbance (78.60%). A total of 3 symptom clusters were identified: a neuropsychological symptom cluster, a weakness⁃gastrointestinal symptom cluster, and a pain⁃sleep symptom cluster, with a cumulative variance contribution of 55.54%. In the symptom network, distress (rs=1.65), nausea (rs=0.96), and pain (rs=0.36) were the core symptoms of the neuropsychological symptom cluster, the weakness⁃gastrointestinal symptom cluster, and the pain⁃sleep symptom cluster, respectively, with the neuropsychological symptom cluster being the central symptom cluster. Distress (rbS=1.095), lack of appetite (rbS=1.039), sleep disturbance (rbS=0.746) were the bridging symptoms. Conclusions Patients with intermediate and advanced hepatocellular carcinoma after surgery experience multiple symptoms. Healthcare providers can strengthen the understanding and assessment of symptom clusters according to the results of network analysis, pay attention to the core symptoms, and provide timely and precise interventions for patients.

Key words: Intermediate and advanced hepatocellular carcinoma, Core symptoms, Symptom clusters, Postoperative；Network analysis, Symptom management