Hepatic resection using intermittent vascular inflow occlusion and low central venous pressure anesthesia improves morbidity and mortality

Hepatic resection results in significant morbidity and mortality primarily related to intraoperative blood loss. Intermittent vascular inflow occlusio n (VO) and low central venous pressure (CVP) during hepatectomy have been u sed to reduce blood loss. To determine the benefit of VO and low CVP, we re viewed the outcomes of 168 consecutive patients who had undergone liver res ection. The results of 78 patients who had undergone hepatic resection betw een 1993 and 1998 with the use of VO and low CVP (post-VO/CVP) were compare d to the previous 90 patients who had undergone hepatectomy without VO and low CVP (pre-VO/CVP) between 1979 and 1992. Hepatectomies were performed fo r metastatic disease (65%), hepatoma (20%), and benign tumors (15%). Resect ions included 18 trisegmentectomies, 67 lobectomies, and 83 segmental resec tions. Patients in both groups were similar with regard to extent of resect ion. Post-VO/CVP patients had significantly lower median estimated blood lo ss (725 mi vs. 2300 mi, P < 0.001). less postoperative morbidity (10.3% vs. 22.2%, P = 0.038), lo ir er in-hospital mortality (2.6% vs. 10%, P = 0.050 ), fewer days in the intensive care unit (1.6 +/- 0.1 days vs. 5.6 +/- 1.2 days, P = 0.003), and shorter overall length of stay (8.0 +/- 0.5 days vs. 15.0 +/- 1.6 days, P < 0.001) than pre-VO/CVP patients. These data suggest that VO and low CVP during liver resection may improve patient outcomes.