Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

Background Low central venous pressure (CVP) affects hemodynamic stability and tissue perfusion. This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma (HCC). Methods Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection. The systolic blood pressure (SBP) was maintained, if possible, at 90 mmHg or higher. Hepatitis B surface antigen was positive in 90 patients (92.8%) and cirrhosis in 84 patients (86.6%). Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes. The average clamp time was 21.4±8.0 minutes. These patients were divided into 5 groups based on the CVP: group A: 0–1 mmHg; B: 1.1–2 mmHg; C: 2.1–3 mmHg; D: 3.1–4 mmHg and E: 4.1–5 mmHg. The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed. Results With active fluid load, a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A (95% CI: 10.8%-26.3%); 39.2% in group B (95% CI: 29.5%-48.9%); 72.2% in group C (95% CI: 63.2%-81.1%); 89.7% in group D (95% CI: 83.6%-95.7%); and 100% in group E (95% CI: 100%-100%). The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in CVP. Compared to groups D and E, blood loss in groups A, B and C was significantly less (analysis of variance test, P 3 − in groups A and B were significantly decreased compared with those in groups C, D and E ( P Conclusion In consideration of blood loss, SBP, base excess and HCO 3 − , a CVP of 2.1–3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.