Infrahepatic Inferior Vena Cava Clamping does not Increase the Risk of Pulmonary Embolism Following Hepatic Resection

Abstract

Background Infrahepatic 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. Methods A 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. Results Of 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. Conclusions Infrahepatic IVC clamping does not increase the incidence of postoperative PE.

Effects of controlled low central venous pressure combined with dexmedetomidine on the blood loss, renal function and cognitive function in patients undergoing laparoscopic hepatectomy

“…Patients in the study group achieved significantly higher MMES scores than those in the control group at postoperative 1 day, 3 days and 7 days (p < 0.05). These results were consistent with previous studies [29,30], which further confirmed the advantage of controlled low central venous pressure combined with dexmedetomidine during laparoscopic hepatectomy resection.…”

Laparoscopic Infrahepatic Inferior Vena Cava Clamping During Liver Resection — a Feasibility Study

“…However, a recent meta-analysis confirmed that IVC-clamping is not associated with increased incidence of PPE in OLR. 4 In this study, we did not observe any case of PPE. Compared to other studies performing LLR without IVC-clamping, our results showed no potential risk or increased morbidity and mortality.…”

Stereotactic Body Radiation Therapy versus Surgical Resection for Stage I/II Hepatocellular Carcinoma

“…This might be due to heterogenous application of SBRT techniques between institutions, including the shift to hypofractionation from three to five fractions over time, as well as the use of heterogenous SBRT doses, and the results should be considered therefore cautiously. Moreover, the lack of data on known prognostic variables such as patients’ liver function treatment-associated toxicity and postoperative liver surgery complications [ 47 , 48 , 49 ], as well as the number and location of lesions (i.e., centrally located tumors with potential vascular invasion), and other second-line treatments after primary surgery or SBRT needs to be mentioned as a limitation of our study that might have introduced bias. Further, there are no data on the treatment of recurrent disease or data on local tumor control.…”