Controlled Low Central Venous Pressure Maintenance Level During Laparoscopic Hepatectomy Negatively Associated with PHLF Incidence: a Retrospective Propensity Score Matching Study

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2024 Dec 18

PMID 39694951

Authors

Zhongqi Liu

Xueying Yang

Hongmei Yang

Zinan Ling

Yao Li

Wei Wu

Fenmei Shi

Fengtao Ji

Affiliations

Soon will be listed here.

Abstract

Background: Posthepatectomy liver failure (PHLF), the most serious complication after hepatectomy, may evoke multisystemic complications and even mortality. Despite numerous studies demonstrated the safety and efficacy of controlled low central venous pressure (CLCVP), the optimal central venous pressure (CVP) maintenance level during CLCVP and its relationship with PHLF remain controversial. Therefore, the present study aimed to evaluate the association between the lowest CVP maintenance level during CLCVP and PHLF.

Methods: 755 patients who underwent laparoscopic hepatectomy at Sun Yat-Sen Memorial Hospital between January 2017 and March 2021 were recruited. Univariate and multivariate analyses were performed to determine the effect of the lowest CVP maintenance level on PHLF. After implementing propensity score matching (PSM) to equalize demographic confounders, univariate comparisons and subgroup analyses were conducted to investigate the impact of the lowest CVP maintenance level on PHLF in patients who underwent CLCVP.

Results: Univariate and multivariate analyses identified intraoperative lowest CVP maintenance level < 2 mmHg as an independent risk factor for PHLF (P = 0.041; OR, 0.520; 95% CI 0.277 to 0.974). Following 1:1 PSM in individuals who received CLCVP, the lowest CVP maintenance level < 2 mmHg was associated with heightened PHLF incidence (P = 0.048) and elevated intraoperative lactate level (P = 0.011). Subgroup analyses revealed that the above effect of the lowest CVP maintenance level occurred mainly in elderly individuals or those with prolonged portal blockade.

Conclusion: During laparoscopic hepatectomy, excessively low CVP maintenance level should be avoided to decrease the risk of tissue malperfusion and PHLF, especially in elderly or prolonged portal blockade patients.

References

Sparrelid E, Olthof P, Dasari B, Erdmann J, Santol J, Starlinger P . Current evidence on posthepatectomy liver failure: comprehensive review. BJS Open. 2022; 6(6). PMC: 9681670. DOI: 10.1093/bjsopen/zrac142. View

Soreide J, Deshpande R . Post hepatectomy liver failure (PHLF) - Recent advances in prevention and clinical management. Eur J Surg Oncol. 2020; 47(2):216-224. DOI: 10.1016/j.ejso.2020.09.001. View

Egeli T, Unek T, Agalar C, Ozbilgin M, Derici S, Cevlik A . The Analysis of Posthepatectomy Liver Failure Incidence and Risk Factors Among Right Liver Living Donors According to International Study Group of Liver Surgery Definition. Transplant Proc. 2019; 51(4):1121-1126. DOI: 10.1016/j.transproceed.2019.01.088. View

Hayashi D, Mizuno T, Kawakatsu S, Baba T, Sando M, Yamaguchi J . Liver remnant volume to body weight ratio of 0.65% as a lower limit in right hepatic trisectionectomy with bile duct resection. Surgery. 2023; 175(2):404-412. DOI: 10.1016/j.surg.2023.09.037. View

Li B, Qin Y, Qiu Z, Ji J, Jiang X . A cohort study of hepatectomy-related complications and prediction model for postoperative liver failure after major liver resection in 1,441 patients without obstructive jaundice. Ann Transl Med. 2021; 9(4):305. PMC: 7944277. DOI: 10.21037/atm-20-5472. View

Lee E, Park S, Han S, Shim J, Park H, Lee S . Risk prediction of post-hepatectomy liver failure in patients with perihilar cholangiocarcinoma. J Gastroenterol Hepatol. 2017; 33(4):958-965. DOI: 10.1111/jgh.13966. View

Hammond J, Guha I, Beckingham I, Lobo D . Prediction, prevention and management of postresection liver failure. Br J Surg. 2011; 98(9):1188-200. DOI: 10.1002/bjs.7630. View

Truant S, Oberlin O, Sergent G, Lebuffe G, Gambiez L, Ernst O . Remnant liver volume to body weight ratio > or =0.5%: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg. 2006; 204(1):22-33. DOI: 10.1016/j.jamcollsurg.2006.09.007. View

Longbotham D, Young A, Nana G, Feltbower R, Hidalgo E, Toogood G . The impact of age on post-operative liver function following right hepatectomy: a retrospective, single centre experience. HPB (Oxford). 2019; 22(1):151-160. DOI: 10.1016/j.hpb.2019.06.014. View

10.

Mai R, Ye J, Long Z, Shi X, Bai T, Chen J . Preoperative aspartate aminotransferase-to-platelet-ratio index as a predictor of posthepatectomy liver failure for resectable hepatocellular carcinoma. Cancer Manag Res. 2019; 11:1401-1414. PMC: 6388945. DOI: 10.2147/CMAR.S186114. View

11.

Lu L, Zhang Y, Mu-Yan C, Kan A, Zhong X, Mei J . Platelet-albumin-bilirubin grade: Risk stratification of liver failure, prognosis after resection for hepatocellular carcinoma. Dig Liver Dis. 2019; 51(10):1430-1437. DOI: 10.1016/j.dld.2019.04.006. View

12.

Yamamoto G, Taura K, Ikai I, Fujikawa T, Nishitai R, Kaihara S . ALPlat criterion for the resection of hepatocellular carcinoma based on a predictive model of posthepatectomy liver failure. Surgery. 2019; 167(2):410-416. DOI: 10.1016/j.surg.2019.09.021. View

13.

Ye J, Mai R, Guo W, Wang Y, Ma L, Xiang B . Nomogram for prediction of the international study Group of Liver Surgery (ISGLS) grade B/C Posthepatectomy liver failure in HBV-related hepatocellular carcinoma patients: an external validation and prospective application study. BMC Cancer. 2020; 20(1):1036. PMC: 7592579. DOI: 10.1186/s12885-020-07480-2. View

14.

Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B . Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg. 2020; 107(3):268-277. DOI: 10.1002/bjs.11406. View

15.

Hobeika C, Guyard C, Sartoris R, Maino C, Rautou P, Dokmak S . Performance of non-invasive biomarkers compared with invasive methods for risk prediction of posthepatectomy liver failure in hepatocellular carcinoma. Br J Surg. 2022; 109(5):455-463. DOI: 10.1093/bjs/znac017. View

16.

Fagenson A, Gleeson E, Pitt H, Lau K . Albumin-Bilirubin Score vs Model for End-Stage Liver Disease in Predicting Post-Hepatectomy Outcomes. J Am Coll Surg. 2020; 230(4):637-645. DOI: 10.1016/j.jamcollsurg.2019.12.007. View

17.

Lee J, Lee J, Park Y, Lee W, Kwon J, Song K . Risk factors of posthepatectomy liver failure for perihilar cholangiocarcinoma: Risk score and significance of future liver remnant volume-to-body weight ratio. J Surg Oncol. 2020; 122(3):469-479. DOI: 10.1002/jso.25974. View

18.

Merath K, Tiwari A, Court C, Parikh A, Dillhoff M, Cloyd J . Postoperative Liver Failure: Definitions, Risk factors, Prediction Models and Prevention Strategies. J Gastrointest Surg. 2023; 27(11):2640-2649. DOI: 10.1007/s11605-023-05834-2. View

19.

van Mierlo K, Schaap F, Dejong C, Olde Damink S . Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure. J Hepatol. 2016; 65(6):1217-1231. DOI: 10.1016/j.jhep.2016.06.006. View

20.

Yu L, Sun H, Jin H, Tan H . The effect of low central venous pressure on hepatic surgical field bleeding and serum lactate in patients undergoing partial hepatectomy: a prospective randomized controlled trial. BMC Surg. 2020; 20(1):25. PMC: 7001244. DOI: 10.1186/s12893-020-0689-z. View