Reduction of Central Venous Pressure in Elective Robotic and Laparoscopic Liver Resection: The PRESSURE Trial-A Randomized Clinical Study.

Summary

In this double-blind RCT of 112 patients undergoing minimally invasive liver resection, deliberate CVP reduction did not decrease intraoperative blood loss but increased intraoperative hemodynamic instability. Ninety-day mortality and overall morbidity were similar between groups.

Key Findings

• Total intraoperative blood loss was equivalent with and without CVP reduction: 280 mL (120–560) vs 360 mL (150–640); P=0.30.
• CVP was higher without reduction during resection (9.3±4.2 vs 3.2±2.2 mmHg; P<0.001), yet blood loss during transection was similar (220 vs 240 mL; P=0.39).
• Intraoperative hemodynamic instability was less frequent without CVP reduction (12% vs 30%; P=0.03); 90-day mortality (5% vs 4%; P=0.68) and morbidity (18% vs 20%; P=0.77) were comparable.

Clinical Implications

Avoid routine CVP-lowering strategies in MILR; prioritize hemodynamic stability over aggressive fluid restriction/venodilation. Maintain standard anesthetic care and use other blood-sparing techniques.

Limitations

• Single RCT with 112 analyzed patients may be underpowered for rare outcomes
• Findings limited to elective minimally invasive liver resections; generalizability to open or high-risk cases uncertain

Future Directions

Multicenter trials to confirm findings, explore patient subgroups (cirrhosis, large resections), and test alternative blood-sparing strategies that preserve hemodynamic stability.