Background and Aims: Application of controlled low central venous pressure (CLCVP) in hepatectomy can effectively reduce the liver cut surface bleeding. However, the relative low blood pressure and potential hypoperfusion resulted from low central venous pressure (CVP) may probably cause harmful effects, which impose certain restrictions on its promotion. The aim of this study was to investigate the effectiveness and safety of using CLCVP technique in laparoscopic hepatectomy for patients with primary liver cancer and concomitant post-hepatitis cirrhosis.  
Methods: The clinical data of 44 patients with primary liver cancer associated post-hepatitis cirrhosis undergoing laparoscopic anatomical hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University from April 2017 to March 2019 were retrospectively analyzed. All patients were operated by the same surgical team, of whom, 24 cases received CLCVP (observation group) and 20 cases did not receive CLCVP (control group) during surgery. The main pre- intra- and postoperative clinical variables of the two groups of patients were analyzed and compared.
Results: There were no significant differences in preoperative data that included the sex, age, BMI, Child classification, degree of cirrhosis between and parameters for liver and renal functions between the two groups of patients (all P>0.05). The operations were uneventfully performed in both groups of patients without perioperative death. No complications associated with low CVP such as gas embolism or liver and renal function injuries occurred in observation group during and after the operation. In observation group compared with control group, the intraoperative arterial systolic blood pressure and CVP were significantly decreased, the operative time and time for hepatic portal occlusion were significantly shortened, and the intraoperative blood loss and blood transfusion rate were significantly reduced, but the intraoperative lactic acid concentration was significantly increased (all P<0.05). There were no significant differences in the incidence rates of postoperative bleeding, infection, pleural effusion and bile leakage as well as the parameters for liver and renal functions, time to tube removal and length of hospital stay between the two groups (all P>0.05), while the postoperative drainage volume in observation group was significantly higher than that in control group (P<0.05). The postoperative tumor recurrence rates showed no significant difference between the two groups (P>0.05).
Conclusion: Based on the premise of accurate evaluation of preoperative liver function and carefully observation of intraoperative perfusion index, CLCVP technique is safe and reliable for laparoscopic hepatectomy in patients with post-hepatitis cirrhosis. Although low CVP can reduce the perfusion, enhance the anaerobic metabolism, and increase the lactic acid content of the body, it has no effect on liver and renal functions as well as the recurrence of the liver cancer. Moreover, the low CVP can effectively reduce intraoperative blood loss and transfusion volume, shorten the operative time and portal occlusion time, and thereby reduce the impact of long-term ischemia and hypoxia on the liver. So, LCVP is a recommended technique for controlling the liver cut surface bleeding in liver cancer patients with post-hepatitis cirrhosis without underlying cardiopulmonary, cerebral and renal diseases.