Hemihepatic versus total hepatic inflow occlusion during hepatectomy: A systematic review and meta-analysis

Table 1 Characteristics of randomized controlled trials comparing total hepatic inflow occlusion with hemihepatic vascular occlusion

Author (yr)	Design	Sample size (n)	THO (n)	HHO (n)	Journal	Comparison
Figueras et al (2005)	RCT	80	39	41	Annals of Surgery	Complete vs selective portal triad clamping
Wu et al (2002)	RCT	58	28	30	Arch Surg	Hemihepatic vs total hepatic occlusion techniques
Yuan et al (2010)	RCT	120	60	60	The American Journal of Surgery	Pringle maneuver vs hemihepatic vascular occlusion
Liang et al (2009)	RCT	80	40	40	Hepato-Gastroen-terology	Continuous hemihepatic with intermittent total hepatic inflow occlusion
Total	--	338	167	171	--	--

THO: Total hepatic inflow occlusion; HHO: Hemihepatic vascular occlusion; RCT: Randomized controlled trials.

Table 2 Characteristics of patients in randomized controlled trials comparing total hepatic inflow occlusion with hemihepatic vascular occlusion

Author (yr)	Age	Sex	Cirrhosis	Ischaemic	Resection margin ( ≤ 1 segments:≥ 2 segments) THO/HHO	Diseases
	(mean yr)	(male:female)	(n:N)	preconditioning		HCC: Others
	THO/HHO	THO/HHO	THO/HHO			THO/HHO
Figueras et al (2005)	61.8/62	31:8/28:13	18:39/21:41	IC	25:14/29:12	16:23/17:24
Wu et al (2002)	57.5/53.2	23:5/25:5	28:28/30:30	IC	5:23/7:23	25:3/26:4
Yuan et al (2010)	48.6/49.3	46:14/41:19	39:60/35:60	IC if transaction time > 30 min or CC	5:55/5:55	44:16/43:17
Liang et al (2009)	49.4/49.55	27:13/31:9	17:40/19:40	IC or CC	6:34/10:30	20:20/21:19
Total	--	127:40/125:46	102:167/105:171	--	41:126/51:120	105:62/107:64

IC: Intermittent clamping; CC: Continuous clamping; HCC: Hepatocellular carcinoma; N: The number of all patients in one trial; n: The number of patients with cirrhosis; THO: Total hepatic inflow occlusion; HHO: Hemihepatic vascular occlusion.

Table 3 Outcomes of randomized controlled trials comparing total hepatic inflow occlusion with hemihepatic vascular occlusion

Author (yr)	Operative time (min)	Ischemic duration (min)	Blood loss (mL)	Transfusion requirements	Complications total (n)	In-hospital stay (d)	In-hospital death (n)
	THO/HHO	THO/HHO	THO/HHO	THO/HHO	THO/HHO	THO/HHO	THO/HHO
Figueras et al (2005)	207 ± 48/219 ± 45	41 ± 14/47 ± 18	671 ± 533/735 ±397	4:39/6:41	15:39/ 12:41	9.38 ± 4.9/8.15 ± 3.8	0:39/1:41
Wu et al (2002)	409 ± 19.2/ 399 ± 15.6	96.0 ± 10.9/ 94.2 ± 9.9	1685 ± 170/ 1159 ± 221	12:28/5:30	8:28/10:30	14.8 ± 1.4/16.4 ± 1.4	0:28/0:30
Yuan et al (2010)	114.2 ± 37.2/ 133.5 ± 44.6	16.6 ± 8.7/ 14.9 ± 4.5	339.5 ± 205.1/ 354.4 ± 240.3	6:60/4:60	19:60/12:60	13.7 ± 5.2/10.2 ±4.1	1:60/0:60
Liang et al (2009)	203.98 ± 38.36/ 236.15 ± 49.2	40.17 ± 13.30/ 42.38 ± 12.79	569.8 ± 285.56/ 649.35 ± 279.05	14:40/15:40	8:40/9:40	9.85 ± 3.55/10.12 ± 2.41	0:40/0:40
Total	--	--	--	36:167/30:171	50:167/43:171	--	1:167/1:171

THO: Total hepatic inflow occlusion; HHO: Hemihepatic vascular occlusion.

Table 4 Postoperative aspartate aminotransferase and alanine aminotransferase levels of patients in randomized controlled trials comparing total hepatic inflow occlusion with hemihepatic vascular occlusion

Author (yr)	AST (U/L)	AST (U/L)	AST (U/L)	ALT (U/L)	ALT (U/L)	ALT (U/L)
	Day 1	Day 3	Day 7	Day 1	Day 3	Day 7
	THO/HHO	THO/HHO	THO/HHO	THO/HHO	THO/HHO	THO/HHO
Wu et al (2002)	420 ± 790/290 ± 770	180 ± 320/190 ± 510	50 ± 40/30 ± 20	370 ± 490/480 ± 510	330 ± 320/320 ± 270	90 ± 20/70 ± 20
Yuan et al (2010)	812.6 ± 475.3/447.6 ±210.3	423.7 ± 265.4/207.5 ± 79.3	143.6 ± 87.5/64.2 ± 29.4	1013.6 ± 654.4/369.4 ± 347.2	592.2 ± 416.4/218.4 ± 185.3	172.4 ± 125.8/ 79.6 ± 55.3
Figueras et al (2005)	NS	NS	NS	402 ± 258/372 ± 234	NS	NS

THO: Total hepatic inflow occlusion; HHO: Hemihepatic vascular occlusion.

Table 5 Assessment the methodological quality of included studies

Author (yr)	Sample size calculation	Generation of allocation sequence	Allocation concealment	Deviations, withdrawals and dropouts	Efficacy of randomization	Blinding	Definition of outcome parameters
Figueras et al (2005)	Yes	No description	Sealed envelope	Yes	Yes	No description	Yes
Wu et al (2002)	No description	No description	Sealed envelope	No description	Yes	No description	Yes
Yuan et al (2010)	Yes	Yes	Sealed envelope	Yes	Yes	Single-blinded	No description
Liang et al (2009)	No description	No description	No description	Yes	Yes	No description	Yes