A Legacy Strategy in a Modern Era: Reassessing Low Central Venous Pressure During Hepatectomy

Low central venous pressure (LCVP) has long been used to reduce bleeding during hepatectomy, but whether its benefit persists in the context of modern liver surgery, particularly minimally invasive approaches, remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing LCVP with conventional central venous pressure management. PubMed, Embase, Web of Science, the Cochrane Library, OVID, Scopus, and ClinicalTrials.gov were searched from inception to January 13, 2026. Primary outcomes were intraoperative blood loss, transfusion volume, and transfusion requirement. Secondary outcomes included postoperative liver function and renal function. Risk of bias was assessed using RoB 2.0, and certainty of evidence was evaluated using GRADE. 15 randomized controlled trials involving 1523 patients were included, with 742 patients in the LCVP group and 781 in the control group. Overall, LCVP significantly reduced intraoperative blood loss (SMD -0.90, 95% CI -1.44 to -0.35), transfusion volume (SMD -0.75, 95% CI -1.00 to -0.50), and the proportion of patients requiring transfusion (OR 0.51, 95% CI 0.36 to 0.74). However, subgroup analysis demonstrated that the reduction in blood loss was primarily observed in open hepatectomy (SMD -1.08, 95% CI -1.82 to -0.33), whereas no significant effect was identified in laparoscopic hepatectomy (SMD -0.50, 95% CI -1.14 to 0.15). These findings suggest that while LCVP remains an effective blood-sparing strategy in open hepatectomy, its benefit in minimally invasive liver resection is uncertain, indicating that its clinical value is context-dependent and may be less pronounced in contemporary surgical practice.