title: Effectiveness and safety of controlled venous pressure in liver surgery: a systematic review and network meta-analysis.
abstract: OBJECTIVE
  To investigate the effectiveness and safety of controlled venous pressure in liver surgery and further to compare the clinical outcomes of low central venous pressure by infrahepatic inferior vena cava clamping (IVCC) and intraoperative anesthetic control (IAC).
  
  
  METHODS
  Online databases including PubMed, Embase, Cochrane Library, Clinical trials.gov, and China biology medicine database were comprehensively searched. After identifying relevant studies out of the search results, quality assessment was performed according to the methods recommended by the Cochrane collaboration. And meta-analysis was performed by both direct comparison and indirect comparison.
  
  
  RESULTS
  Thirteen studies containing 1252 patients were included. Compared with control, controlled venous pressure significantly decreased central venous pressure, total blood loss, blood loss during transection, transfusion rate, and total incidence of complications. Further analysis of IVCC and IAC showed that there was no significant difference in aspects of main clinical outcomes.
  
  
  CONCLUSIONS
  Controlled venous pressure significantly decreased central venous pressure and achieved improvement of bleeding control in liver surgery. It reduced total incidence of complications and chest infection, while it caused concerns about heart disorder. Although IVCC was not worse than IAC in therapeutic effect, a superiority between them still needs to be explored.
authors.affiliation: Department of Orthopaedic, The First Hospital of Lanzhou University, Lanzhou 730000, China ; Lanzhou University, Lanzhou 730000, China.
authors.forename: Xue Liang
authors.initials: XL
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic, The First Hospital of Lanzhou University, Lanzhou 730000, China.
authors.forename: Wen Ji
authors.initials: WJ
authors.lastname: Wang
authors.affiliation: Department of Emergency, The First Hospital of Lanzhou University, Lanzhou 730000, China.
authors.forename: Wen Jin
authors.initials: WJ
authors.lastname: Wang
authors.affiliation: Lanzhou University, Lanzhou 730000, China ; Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China.
authors.forename: Nong
authors.initials: N
authors.lastname: Cao
mesh_terms: D000758:Anesthesia; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002496:Central Venous Pressure; D003250:Constriction; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008099:Liver / Q000601:surgery*; D012449:Safety; D016896:Treatment Outcome; D014682:Vena Cava, Inferior