P-L03 The efficacy and safety of controlled low central venous pressure for liver resection: a systematic review and meta-analysis

Background Partial hepatectomy is an effective treatment for benign and malignant liver diseases . However, intraoperative bleeding is one of the major factors affecting the outcome of hepatectomy. Currently, the most commonly used method of hepatic blood flow occlusion in clinical practice is Pringle method, but this method has a great impact on liver function and can cause hepatic ischemia-reperfusion injury. .Studies have shown that blood loss volume during hepatectomy is related to central venous pressure (CVP) . Intraoperative control of central venous pressure (LCVP) is increasingly popular in hepatectomy, but its effectiveness and safety remain controversial. Methods The main result of the analysis was to reduce the blood loss and blood infusion. Secondary outcomes included operative time, fluid infusion, urine volume, ALT, TBIL, BUN, CR, postoperative complication rates and length of hospital stay. Statistical analysis was performed using RevMan 5.3 software (Cochrane Collaboration, Oxford, England). The results of all studies were measured by mean ± standard deviation. If there is significant heterogeneity between the results (P < 0.05), a random-effects model is used. A fixed-effect model was used when there was no significant heterogeneity (P > 0.05). Heterogeneity was assessed using the Cochrane χ2 text . Results In total, 10 studies, involving 324 patients undergoing liver resection with controlled low central venous pressure, were identified. Meta-analysis showed that blood loss in the LCVP group was significantly less than that in the control group ( P = 0.0002). blood transfusion in the LCVP group was also significantly less than that in the control group(P = 0.0006). there was no difference between LCVP group and control group in operation time(P = 0.17), fluid infusion( P = 0.46), urinary volume(P = 0.38), ALT( P = 0.23), TBIL(P = 0.86), BUN(P = 0.67), CR(P =0.59), postoperative complication rates( P = 0.01) and hospital stay(P = 0.26). Conclusions Compared with the control, controlled low central venous pressure showed comparable efficacy and safety for the treatment during liver resection.