Systematic review and meta-analysis of the effect of portal triad clamping on outcome after hepatic resection.
BACKGROUND
The effect of portal triad clamping (PTC) on outcome after hepatic resection is uncertain.


METHODS
A systematic literature search was conducted to detect randomized controlled trials (RCTs) assessing the effectiveness and safety of PTC alone and of PTC with ischaemic preconditioning (IPC) of the liver. Studies on clamping of the inferior vena cava or hepatic veins were excluded. Endpoints included postoperative overall morbidity and mortality, cardiopulmonary and hepatic morbidity, blood loss, transfusion rates and alanine aminotransferase (ALT) levels. Meta-analyses were performed using a random-effects model.


RESULTS
Eight RCTs published between 1997 and 2006 containing a total of 558 patients were eligible for final analysis. The design of the identified studies varied considerably. Analyses of endpoints revealed no difference between intermittent PTC and no PTC. Meta-analyses of PTC with and without previous IPC revealed no differences, but postoperative ALT levels were significantly lower with IPC.


CONCLUSIONS
On currently available evidence, the routine use of PTC does not offer any benefit in perioperative outcome after liver resection. It cannot be recommended as a standard procedure.
Rahbari
N N
NN
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Wente
M N
MN
Schemmer
P
P
Diener
M K
MK
Hoffmann
K
K
Motschall
E
E
Schmidt
J
J
Weitz
J
J
Büchler
M W
MW
D000410:Alanine Transaminase / Q000378:metabolism; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003250:Constriction; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008107:Liver Diseases / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery*; D015337:Multicenter Studies as Topic; D011168:Portal System / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000410:Alanine Transaminase