Abstract
BackgroundInfrahepatic inferior vena cava (IVC) clamping reduces central venous pressure. However, controversies remain regarding its impact on postoperative complications, particularly, the incidence of postoperative pulmonary embolism (PE). The aim of the study was to determine the impact of IVC clamping on the incidence of PE in patients undergoing hepatectomy.MethodsA pooled analysis of five prospective trials on patients who underwent hepatic resection over a period of 10 years was performed. Patients with infrahepatic IVC clamping were compared to patients without infrahepatic IVC clamping. Outcomes were studied by univariate and multivariate analyses.ResultsOf 505 included patients, 141 patients had IVC clamping and 364 patients served as control group. The rate of postoperative PE was comparable between groups (3% vs. 3%; P = 0.762), as were postoperative morbidity (P = 0.932), bile leakage (P = 0.272), posthepatectomy hemorrhage (P = 0.095), and posthepatectomy liver failure (P = 0.605), respectively. No clinicopathological and intraoperative risk factors were found to predict the onset of PE. Subgroup analyses of patients with major hepatectomy and vascular resections confirmed no adverse perioperative outcomes to be associated with IVC clamping.ConclusionsInfrahepatic IVC clamping does not increase the incidence of postoperative PE.
Highlights
Hepatic resection is the treatment of choice for benign and malignant liver tumors [1, 2]
The rate of postoperative pulmonary embolism (PE) was comparable between groups (3% vs. 3%; P = 0.762), as were postoperative morbidity (P = 0.932), bile leakage (P = 0.272), posthepatectomy hemorrhage (P = 0.095), and posthepatectomy liver failure (P = 0.605), respectively
Subgroup analyses of patients with major hepatectomy and vascular resections confirmed no adverse perioperative outcomes to be associated with inferior vena cava (IVC) clamping
Summary
Hepatic resection is the treatment of choice for benign and malignant liver tumors [1, 2]. Various intraoperative strategies to limit blood loss were developed including low central venous pressure (CVP) during hepatic transection and vascular occlusion techniques [5, 6]. Infrahepatic clamping of the inferior vena cava (IVC) is a method of outflow control to maintain a low CVP. Infrahepatic inferior vena cava (IVC) clamping reduces central venous pressure. The aim of the study was to determine the impact of IVC clamping on the incidence of PE in patients undergoing hepatectomy. The rate of postoperative PE was comparable between groups (3% vs 3%; P = 0.762), as were postoperative morbidity (P = 0.932), bile leakage (P = 0.272), posthepatectomy hemorrhage (P = 0.095), and posthepatectomy liver failure (P = 0.605), respectively. Subgroup analyses of patients with major hepatectomy and vascular resections confirmed no adverse perioperative outcomes to be associated with IVC clamping
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