Usefulness of infra-hepatic inferior vena cava clamping during liver resection: a meta-analysis of randomized controlled trials

Background: Infra-hepatic vena cava clamping (IIVCC) may reduce blood losses during liver resection. However, available literature is limited to reports from single institutions with a small sample size. To overcome those limitations, we performed a meta-analysis to examine the association between IIVCC and surgical outcomes. Methods: A systematic literature review was conducted to identify RCTs reporting on quantitative data on IIVCC. Random effects logistic regression calculated the pooled odds ratio (OR) for each surgical outcome. Results: Six studies were identified that included 714 patients, of whom 359 received IIVCC and 355 did not. Patients receiving IIVCC had significantly less total blood loss (MD − 353.08, 95% CI − 393.36 to 312.81, P < 0.00001), blood loss during parenchymal transection (MD − 243.28, 95% CI − 311.67 to − 174.88, P < 0.0001), blood loss volume per transection area (MD − 1.63, 95% CI − 2.14 to − 1.13, P < 0.00001), and intraoperative blood transfusion (OR 0.45, 95% CI 0.23 to 0.89, P = 0.02). Operative time was similar in the two groups (MD − 2.89, 95% CI − 18.45 to 12.68, P = 0.72). No differences between groups were observed in central venous pressure, heart rate, and mean arterial pressure before, after, and during parenchymal transection. Rates of overall morbidity (OR 0.79, 95% CI 0.56–1.13, P = 0.20), major complications (OR 0.89, 95% CI 0.47–1.80, P = 0.73), and perioperative mortality (OR 1.32, 95% CI 0.29–6.09, P = 0.72) were similar in the two groups. Conclusions: IIVCC was associated to decreased blood loss (overall, during parenchymal transection, and per transection area) and decreased intraoperative transfusions, in the absence of increased operative times.