Effects of controlled low central venous pressure on organ function during hepatectomy: Current progress

Hepatectomy is an effective and widely adopted surgical technique for treating various liver diseases. However, owing to the liver's unique anatomical structure and rich blood supply, hepatectomy poses considerable challenges. The most critical challenge is intraoperative bleeding, which is closely associated with postoperative complications and patient mortality. This has driven the pursuit of effective and safe strategies to minimize bleeding during hepatectomy. Managing a low central venous pressure of <5 cm H₂O or 3 mmHg has been shown to significantly reduce hepatic vein bleeding and provide optimal surgical visibility during hepatectomy. Before the routine application of low central venous pressure management, bleeding during hepatectomy was often associated with unacceptably high morbidity and mortality rates. Although this technique has been demonstrated to be safe and effective in multiple studies of hepatectomy and transplantation, its widespread adoption remains limited. Concerns have been raised regarding morbidity related to insufficient perfusion to vital organs during the low central venous pressure phase of hepatectomy. This review has discussed recent developments concerning the effects of low central venous pressure management during hepatectomy on the function of critical organs.