A Cochrane review [Abstract] 1 included 5 studies with a total of 331 subjects. 3 of the 5 studies comparing vascular occlusion and no vascular occlusion used intermittent vascular occlusion and 2 studies used continuous vascular occlusion. There was no difference in mortality (RR 0.56, 95% CI 0.12 to 2.55), liver failure (RR 0.06, 95% CI 0.09 to 2.63), or other morbidities. The blood loss was significantly lower in vascular occlusion compared with no vascular occlusion (MD -755.31 ml, 95% CI -1081.58 to -429.04). There was a statistical significant higher aspartate aminotransferase (AST) in the vascular occlusion group on the first and second post-operative day (POD) than the no vascular occlusion group in the only trial that reported AST on the first two PODs (MD 254.00, 95% CI 43.41 to 464.59 and MD 158.00, 95% CI 20.38 to 295.62). There was no statistically significant difference between the two groups on the third or seventh PODs. The alanine transferase (ALT) was statistically significantly higher on the first, second, third, and seventh PODs in the vascular occlusion group.
Continuous vascular occlusion was used in 2 trials; in 1 trial, cirrhotic patients were excluded and in the other trial, only 3 cirrhotic patients underwent liver resection using continuous vascular occlusion. Thus the safety of continuous vascular occlusion in cirrhotic patients has not been established.
Comment: The quality of evidence is downgraded by study quality (lack of blinding and selective reporting of outcomes), by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (few outcome events and wide confidence intervals).
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