Methods to decrease blood loss during liver resection: a network meta‐analysis

Elisabetta Moggia; Benjamin Rouse; Constantinos Simillis; Tianjing Li; Jessica Vaughan; Brian R Davidson; Kurinchi Selvan Gurusamy

doi:10.1002/14651858.CD010683.pub3

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Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

The network plot showing the comparisons in the trials included in the comparison of cardiopulmonary interventions in which network meta‐analysis was performed. The size of the node (circle) provides a measure of the number of trials in which the particular treatment was included as one of the arms. The thickness of the line provides a measure of the number of direct comparisons between two nodes (treatments).

ANH: acute normovolemic haemodilution; CVP: central venous pressure; RBC: red blood cells.

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Figure 5

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for blood transfusion (red blood cells) (cardiopulmonary interventions). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

ANH: acute normovolemic haemodilution; CVP: central venous pressure; RBC: red blood cells.

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Figure 6

Cumulative probability of being best treatment: cumulative probability of being best for each treatment for cardiopulmonary interventions. Rank 1 indicates the probability that a treatment is best, rank 2 indicates the probability that a treatment is in the two best treatments, rank 3 indicates the probability that a treatment is in the three best treatments, and so on.

ANH: acute normovolemic haemodilution; CVP: central venous pressure; RBC: red blood cells.

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Figure 7

Cardiopulmonary intervention: blood transfusion (red blood cells)

Forest plot of the comparisons in which direct and indirect estimates were available. The mean effect is in opposite directions in the indirect estimate and the direct estimates, thus suggesting that there may be discrepancies between direct and indirect estimates. Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence.

¹ Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
² Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).
⁴There was substantial or considerable heterogeneity (downgraded by 2 points).

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Figure 8

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for blood loss (cardiopulmonary interventions). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

ANH: acute normovolemic haemodilution; CVP: central venous pressure.

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Figure 9

Cardiopulmonary intervention: blood loss

Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence.

ANH: acute normovolemic haemodilution; CVP: central venous pressure.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).
⁴There was substantial or considerable heterogeneity (downgraded by 2 points).

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Figure 10

The network plot showing the comparisons in the trials included in the comparison of methods for parenchymal transection in which network meta‐analysis was performed. The size of the node (circle) provides a measure of the number of trials in which the particular treatment was included as one of the arms. The thickness of the line provides a measure of the number of direct comparisons between two nodes (treatments).

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

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Figure 11

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for adverse events (proportion) (parenchymal transection methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

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Figure 12

Cumulative probability of being best treatment: cumulative probability of being best for each treatment for parenchymal transection methods. Rank 1 indicates the probability that a treatment is best, rank 2 indicates the probability that a treatment is in the two best treatments, rank 3 indicates the probability that a treatment is in the three best treatments, and so on.

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

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Figure 13

Parenchymal transection: adverse events (proportion)

Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence.

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).
⁴There was substantial or considerable heterogeneity (downgraded by 2 points).

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Figure 14

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for adverse events (number) (parenchymal transection methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

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Figure 15

Parenchymal transection: adverse events (number)

Forest plot of the comparisons in which direct and indirect estimates were available. There does not appear to be any discrepancy between the direct and indirect estimates.

Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence.

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).

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Figure 16

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for blood transfusion (proportion) (parenchymal transection methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

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Figure 17

Parenchymal transection:blood transfusion (proportion)

Forest plot of the comparisons in which direct and indirect estimates were available. There does not appear to be any discrepancy between the direct and indirect estimates, although the indirect estimates have wide credible intervals for some comparisons. There was little apparent difference in the quality of evidence between direct, indirect estimates, and network meta‐analysis; so, we could not choose one estimate over the others based on the quality of evidence.

CUSA: cavitron ultrsonic surgical aspirator; RFDS: radiofrequency dissecting sealer.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).

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Figure 18

The network plot showing the comparisons in the trials included in the comparison of methods for vascular occlusion in which network meta‐analysis was performed. The size of the node (circle) provides a measure of the number of trials in which the particular treatment was included as one of the arms. The thickness of the line provides a measure of the number of direct comparisons between two nodes (treatments).

Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping; RBC: red blood cells.

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Figure 19

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for serious adverse events (proportion) (vascular occlusion methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping.

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Figure 20

Cumulative probability of being best treatment: cumulative probability of being best for each treatment for vascular occlusion methods. Rank 1 indicates the probability that a treatment is best, rank 2 indicates the probability that a treatment is in the two best treatments, rank 3 indicates the probability that a treatment is in the three best treatments, and so on.

Con: continuous; Int: intermittent; HVE:hepatic vascular exclusion; PTC: portal triad clamping.

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Figure 21

Methods of vascular occlusion: serious adverse events (proportion)

Forest plot of the comparisons in which direct and indirect estimates were available. Although there is overlap of confidence intervals, the mean indirect estimate seems to be quite different from the direct estimate (sometimes, suggesting an opposite effect), thus suggesting that there may be discrepancies between direct and indirect estimates.

There was little apparent difference in the quality of evidence between direct, indirect estimates, and network meta‐analysis; so, we could not choose one estimate over the others based on the quality of evidence.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).

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Figure 22

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for adverse events (proportion) (vascular occlusion methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping.

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Figure 23

Methods of vascular occlusion: adverse events (proportion)

Forest plot of the comparisons in which direct and indirect estimates were available. There does not appear to be any discrepancies between direct and indirect estimates. Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).

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Figure 24

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for blood transfusion (proportion) (vascular occlusion methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping.

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Figure 25

Methods of vascular occlusion: blood transfusion (proportion)

Forest plot of the comparisons in which direct and indirect estimates were available. Although the confidence intervals overlap, there appear to be some discrepancies between direct and indirect estimates for continuous portal triad clamping versus control, intermittent portal triad clamping versus control, and intermittent portal triad clamping versus continuous portal triad clamping. Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).
⁴There was substantial or considerable heterogeneity (downgraded by 2 points).

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Figure 26

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for blood transfusion (red blood cells) (vascular occlusion methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. Intermittent selective portal triad clamping has about 90% probability of being best treatment. However, other random and systematic errors make this finding unreliable.

Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping.

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Figure 27

Methods of vascular occlusion:blood transfusion (red blood cells)

Forest plot of the comparisons in which direct and indirect estimates were available. There do not appear to be any discrepancies between direct and indirect estimates, although the credible intervals are different (the direct evidence had narrower credible intervals in four of the five comparisons above) resulting in the differences in the comparisons in which there was evidence for difference. Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence for the comparison 'continuous selective portal triad clamping versus continuous portal triad clamping'. Indirect evidence and network meta‐analysis appear to be preferable over direct evidence for the comparison 'continuous portal triad clamping versus control'. Direct evidence and network meta‐analysis appear to be preferable over indirect evidence for the comparison 'intermittent portal triad clamping versus control'. There was little apparent difference in the quality of evidence between direct, indirect estimates, and network meta‐analysis; so, we could not choose one estimate over the others based on the quality of evidence.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
²Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).

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Figure 28

Probability of best treatment: probability of being best, second best, third best, etc. for each treatment for blood loss (vascular occlusion methods). A probability of more than 90% is a reliable indicator that a treatment is best with regards to the specific outcome. A probability of less than 90% is less reliable. None of the treatments have a 90% probability of being best treatment.

Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping.

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Figure 29

Methods of vascular occlusion:blood loss

Forest plot of the comparisons in which direct and indirect estimates were available. There does not appear to be any discrepancies between direct and indirect estimates, although the credible intervals are different (the direct evidence had narrower credible intervals in three of the five comparisons above). Direct evidence appears to be preferable over indirect evidence and network meta‐analysis based on the quality of evidence.

¹Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
² Sample size was low (downgraded by 1 point).
³Confidence intervals spanned no effect and clinically significant effect (downgraded by 1 point).Ç
⁴There was substantial or considerable heterogeneity (downgraded by 2 points).

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Figure 30

Funnel plot of blood transfusion (proportion): The funnel plot shows funnel plot asymmetry (i.e. some trials with large variance with large effects favouring one treatment were not matched by other trials with similarly large variance with large effects favouring the other treatment). This may be evidence of reporting bias or could be because of heterogeneity between the studies.

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Figure 31

Funnel plot of blood transfusion (red blood cells): The funnel plot shows funnel plot asymmetry (i.e. some trials with large variance with large effects favouring one treatment were not matched by other trials with similarly large variance with large effects favouring the other treatment). This may be evidence of reporting bias or could be because of heterogeneity between the studies.

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Figure 32

Funnel plot of blood loss: The funnel plot shows funnel plot asymmetry (i.e. some trials with large variance with large effects favouring one treatment were not matched by other trials with similarly large variance with large effects favouring the other treatment). This may be evidence of reporting bias or could be because of heterogeneity between the studies.

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Analysis 1.1

Comparison 1 Anterior approach vs conventional approach, Outcome 1 Mortality (perioperative).

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Analysis 1.2

Comparison 1 Anterior approach vs conventional approach, Outcome 2 Serious adverse events (proportion).

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Analysis 1.3

Comparison 1 Anterior approach vs conventional approach, Outcome 3 Adverse events (proportion).

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Analysis 1.4

Comparison 1 Anterior approach vs conventional approach, Outcome 4 Adverse events (number).

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Analysis 1.5

Comparison 1 Anterior approach vs conventional approach, Outcome 5 Blood transfusion (proportion).

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Analysis 1.6

Comparison 1 Anterior approach vs conventional approach, Outcome 6 Major blood loss (proportion).

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Analysis 2.1

Comparison 2 Autologous blood donation vs control, Outcome 1 Adverse events (proportion).

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Analysis 2.2

Comparison 2 Autologous blood donation vs control, Outcome 2 Blood transfusion (proportion).

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Analysis 2.3

Comparison 2 Autologous blood donation vs control, Outcome 3 Blood transfusion (red blood cell).

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Analysis 2.4

Comparison 2 Autologous blood donation vs control, Outcome 4 Blood loss.

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Analysis 2.5

Comparison 2 Autologous blood donation vs control, Outcome 5 Major blood loss (proportion).

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Analysis 2.6

Comparison 2 Autologous blood donation vs control, Outcome 6 Total hospital stay.

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Analysis 2.7

Comparison 2 Autologous blood donation vs control, Outcome 7 Operating time.

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Analysis 3.1

Comparison 3 Cardiopulmonary interventions, Outcome 1 Mortality (perioperative).

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Analysis 3.2

Comparison 3 Cardiopulmonary interventions, Outcome 2 Serious adverse events (proportion).

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Analysis 3.3

Comparison 3 Cardiopulmonary interventions, Outcome 3 Serious adverse events (number).

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Analysis 3.4

Comparison 3 Cardiopulmonary interventions, Outcome 4 Adverse events (proportion).

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Analysis 3.5

Comparison 3 Cardiopulmonary interventions, Outcome 5 Adverse events (number).

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Analysis 3.6

Comparison 3 Cardiopulmonary interventions, Outcome 6 Blood transfusion (proportion).

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Analysis 3.7

Comparison 3 Cardiopulmonary interventions, Outcome 7 Blood transfusion (red blood cell).

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Analysis 3.8

Comparison 3 Cardiopulmonary interventions, Outcome 8 Blood transfusion (fresh frozen plasma).

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Analysis 3.9

Comparison 3 Cardiopulmonary interventions, Outcome 9 Blood transfusion (cryoprecipitate).

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Analysis 3.10

Comparison 3 Cardiopulmonary interventions, Outcome 10 Blood loss.

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Analysis 3.11

Comparison 3 Cardiopulmonary interventions, Outcome 11 Major blood loss (proportion).

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Analysis 3.12

Comparison 3 Cardiopulmonary interventions, Outcome 12 Hospital stay.

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Analysis 3.13

Comparison 3 Cardiopulmonary interventions, Outcome 13 Operating time.

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Analysis 4.1

Comparison 4 Methods of parenchymal transection, Outcome 1 Mortality (perioperative).

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Analysis 4.2

Comparison 4 Methods of parenchymal transection, Outcome 2 Serious adverse events (proportion).

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Analysis 4.3

Comparison 4 Methods of parenchymal transection, Outcome 3 Serious adverse events (number).

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Analysis 4.4

Comparison 4 Methods of parenchymal transection, Outcome 4 Adverse events (proportion).

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Analysis 4.5

Comparison 4 Methods of parenchymal transection, Outcome 5 Adverse events (number).

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Analysis 4.6

Comparison 4 Methods of parenchymal transection, Outcome 6 Blood transfusion (proportion).

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Analysis 4.7

Comparison 4 Methods of parenchymal transection, Outcome 7 Blood transfusion (red blood cell).

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Analysis 4.8

Comparison 4 Methods of parenchymal transection, Outcome 8 Blood transfusion (fresh frozen plasma).

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Analysis 4.9

Comparison 4 Methods of parenchymal transection, Outcome 9 Blood loss.

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Analysis 4.10

Comparison 4 Methods of parenchymal transection, Outcome 10 Operating time.

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Analysis 5.1

Comparison 5 Methods of dealing with cut surface, Outcome 1 Mortality (perioperative).

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Analysis 5.2

Comparison 5 Methods of dealing with cut surface, Outcome 2 Serious adverse events (proportion).

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Analysis 5.3

Comparison 5 Methods of dealing with cut surface, Outcome 3 Serious adverse events (number).

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Analysis 5.4

Comparison 5 Methods of dealing with cut surface, Outcome 4 Adverse events (proportion).

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Analysis 5.5

Comparison 5 Methods of dealing with cut surface, Outcome 5 Adverse events (number).

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Analysis 5.6

Comparison 5 Methods of dealing with cut surface, Outcome 6 Blood transfusion (proportion).

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Analysis 5.7

Comparison 5 Methods of dealing with cut surface, Outcome 7 Blood transfusion (red blood cell).

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Analysis 5.8

Comparison 5 Methods of dealing with cut surface, Outcome 8 Blood transfusion (fresh frozen plasma).

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Analysis 5.9

Comparison 5 Methods of dealing with cut surface, Outcome 9 Blood loss.

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Analysis 5.10

Comparison 5 Methods of dealing with cut surface, Outcome 10 Total hospital stay.

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Analysis 5.11

Comparison 5 Methods of dealing with cut surface, Outcome 11 ITU stay.

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Analysis 5.12

Comparison 5 Methods of dealing with cut surface, Outcome 12 Operating time.

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Analysis 6.1

Comparison 6 Methods of vascular occlusion, Outcome 1 Mortality (perioperative).

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Analysis 6.2

Comparison 6 Methods of vascular occlusion, Outcome 2 Serious adverse events (proportion).

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Analysis 6.3

Comparison 6 Methods of vascular occlusion, Outcome 3 Serious adverse events (number).

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Analysis 6.4

Comparison 6 Methods of vascular occlusion, Outcome 4 Adverse events (proportion).

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Analysis 6.5

Comparison 6 Methods of vascular occlusion, Outcome 5 Adverse events (number).

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Analysis 6.6

Comparison 6 Methods of vascular occlusion, Outcome 6 Blood transfusion (proportion).

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Analysis 6.7

Comparison 6 Methods of vascular occlusion, Outcome 7 Blood transfusion (red blood cell).

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Analysis 6.8

Comparison 6 Methods of vascular occlusion, Outcome 8 Blood loss.

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Analysis 6.9

Comparison 6 Methods of vascular occlusion, Outcome 9 Major blood loss (proportion).

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Analysis 6.10

Comparison 6 Methods of vascular occlusion, Outcome 10 Total hospital stay.

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Analysis 6.11

Comparison 6 Methods of vascular occlusion, Outcome 11 ITU stay.

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Analysis 6.12

Comparison 6 Methods of vascular occlusion, Outcome 12 Operating time.

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Analysis 7.1

Comparison 7 Pharmacological interventions, Outcome 1 Mortality (perioperative).

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Analysis 7.2

Comparison 7 Pharmacological interventions, Outcome 2 Serious adverse events (proportion).

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Analysis 7.3

Comparison 7 Pharmacological interventions, Outcome 3 Serious adverse events (number).

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Analysis 7.4

Comparison 7 Pharmacological interventions, Outcome 4 Adverse events (proportion).

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Analysis 7.5

Comparison 7 Pharmacological interventions, Outcome 5 Adverse events (number).

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Analysis 7.6

Comparison 7 Pharmacological interventions, Outcome 6 Blood transfusion (proportion).

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Analysis 7.7

Comparison 7 Pharmacological interventions, Outcome 7 Blood transfusion (fresh frozen plasma).

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Analysis 7.8

Comparison 7 Pharmacological interventions, Outcome 8 Blood loss.

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Analysis 7.9

Comparison 7 Pharmacological interventions, Outcome 9 Hospital stay.

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Analysis 7.10

Comparison 7 Pharmacological interventions, Outcome 10 Operating time.

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Methods to decrease blood loss during liver resection: a network meta‐analysis. Primary outcomes
Patient or population: people undergoing liver resection Settings: secondary or tertiary setting Intervention and control: various treatments Follow‐up: until discharge or 1 month (except for mortality (long‐term follow‐up) which was reported at 1 year
Outcomes	Anterior approach versus conventional approach	Autologous blood donation versus control	Cardiopulmonary interventions	Methods of parenchymal transection	Methods of dealing with cut surface	Methods of vascular occlusion	Pharmacological interventions
Treatments The first treatment listed is the control. The remaining are interventions.	Conventional approach Anterior approach	Control Autologous blood donation	Control Acute normovolemic haemodilution plus low central venous pressure Hypoventilation Low central venous pressure	Clamp‐crush method Cavitron ultrasonic surgical aspirator Hydrojet Radiofrequency dissecting sealer Sharp transection method Stapler	Control Argon beam Collagen Cyanoacrylate Fibrin sealant Fibrin sealant plus collagen Oxidised cellulose Plasmajet	Control Continuous hepatic vascular exclusion Continuous portal triad clamping Continuous selective hepatic vascular exclusion Continuous selective portal triad clamping Intermittent portal triad clamping Intermittent selective portal triad clamping	Control Anti‐thrombin III Recombinant factor VIIa Tranexamic acid
Link for detailed 'Summary of Findings tables'	Table 14	Table 15	Table 16	Table 17	Table 18	Table 19	Table 20
Mortality (perioperative)	There was no evidence of differences in perioperative mortality between the 2 groups. Quality of evidence = very low^1,2,3.	There was no evidence of differences in perioperative mortality between the two groups. Quality of evidence = very low^1,2,3.	There was no evidence of differences in perioperative mortality for any of the comparisons. Quality of evidence = very low^1,2,3.	There was no evidence of differences in perioperative mortality for any of the comparisons. Quality of evidence = very low^1,2,3.	There was no evidence of differences in perioperative mortality for any of the comparisons Quality of evidence = very low^1,2,3.	There was no evidence of differences in perioperative mortality for any of the comparisons. Quality of evidence = very low^1,2,3.	There was no evidence of differences in perioperative mortality for any of the comparisons. Quality of evidence = very low^1,2,3.
Mortality (longest follow‐up)	None of the trials reported this outcome.	There was no evidence of differences in mortality at 1 year between the 2 groups. Quality of evidence = very low)^1,2,3.	None of the trials reported this outcome.	None of the trials reported this outcome.	None of the trials reported this outcome.	None of the trials reported this outcome.	None of the trials reported this outcome.
Serious adverse events (proportion)	There was no evidence of differences in the proportion of participants experiencing serious adverse events between the 2 groups. Quality of evidence = very low^1,2,3.	None of the trials reported this outcome.	There was no evidence of differences in the proportion of participants experiencing serious adverse events (for any of the comparisons Quality of evidence = very low^1,2,3.	There was no evidence of differences in the proportion of participants experiencing serious adverse events for any of the comparisons Quality of evidence = very low^1,2,3.	There was no evidence of differences in the proportion of participants experiencing serious adverse events for any of the comparisons Quality of evidence = very low^1,2,3.	The proportion of participants experiencing serious adverse events^a was lower in continuous selective portal triad clamping than continuous portal triad clamping Proportion with serious adverse events in continuous portal triad clamping: 367 per 1000 Proportion with serious adverse events in continuous selective portal triad clamping: 154 per 1000 (66 to 352) Relative effect: OR 0.42, 95% CrI 0.18 to 0.96 120 participants; 1 study. Quality of evidence = very low^1,2,3. There was no evidence of differences in other comparisons. Quality of evidence = very low^1,2,3	There was no evidence of differences in the proportion of participants experiencing serious adverse events for any of the comparisons Quality of evidence = very low^1,2,3.
Serious adverse events (number)	None of the trials reported this outcome.	None of the trials reported this outcome.	There was no evidence of differences in the number of serious adverse events for any of the comparisons Quality of evidence = very low^1,2,3.	The number of serious adverse events was higher in radiofrequency dissecting sealer than clamp‐crush method. Serious adverse rate in clamp‐crush method: 53 per 1000 Serious adverse rate in radiofrequency dissecting sealer: 193 per 1000 (66 to 740) Relative effect: rate ratio 3.64, 95% CrI 1.25 to 13.97. 130 participants; 2 studies. Quality of evidence = low^1,2. There was no evidence of differences in other comparisons. Quality of evidence = very low^1,2,3.	The number of serious adverse events was higher in fibrin sealant than argon beam. Serious adverse event rate in argon beam: 65 per 1000 Serious adverse event rate in fibrin sealant: 313 per 1000 (112 to 1138) Relative effect: rate ratio 4.81, 95% CrI 1.73 to 17.5. 121 participants; 1 study. Quality of evidence = low^1,2. There was no evidence of differences in other comparisons. Quality of evidence = very low^1,2,3.	The number of serious adverse events was lower in intermittent portal triad clamping than continuous portal triad clamping. Serious adverse event rate in continuous portal triad clamping: 136 per 1000 Serious adverse event rate in intermittent portal triad clamping: 12 per 1000 (0 to 76) Relative effect: rate ratio 0.09, 95% CrI 0.00 to 0.56 86 participants; 1 study. Quality of evidence = low^1,2. There was no evidence of differences in other comparisons Quality of evidence = very low^1,2,3.	There was no evidence of differences in the number of serious adverse events for any of the comparisons Quality of evidence = very low^1,2,3.
Health‐related quality of life	None of the trials reported this outcome.	None of the trials reported this outcome.	None of the trials reported this outcome at any time point.	None of the trials reported this outcome at any time point.	None of the trials reported this outcome at any time point.	None of the trials reported this outcome at any time point.	None of the trials reported this outcome at any time point.
CrI: credible intervals; OR: odds ratio.
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Risk of bias was unclear or high in the trial(s) (downgraded by 1 point). ² Sample size was low (total number of participants fewer than 400 for continuous outcomes and fewer than 300 events in total in both groups for other outcomes) (downgraded by 1 point). ³ Credible intervals spanned no effect and clinically significant effect (20% relative risk reduction for binary outcomes; standardised mean difference of 0.5 for health‐related quality of life) (downgraded by 1 point). ^a Network meta‐analysis was performed for this outcome because of the availability of direct and indirect comparisons in the network. The remaining outcomes were analysed by direct comparisons.

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Table 14. Detailed 'Summary of findings' table: anterior approach vs conventional approach

Outcomes	*Illustrative comparative risks (95% CrI)**		Relative effect (95% CrI)	No of participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Intervention
Mortality (perioperative)	76 per 1000	19 per 1000 (2 to 82)	OR 0.23 (0.03 to 1.08)	185 (2 studies)	⊕⊝⊝⊝ Very low^1,2,3
Mortality (longest follow‐up)	None of the trials reported this outcome.
Serious adverse events (proportion)	125 per 1000	154 per 1000 (40 to 457)	OR 1.27 (0.29 to 5.89)	65 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Serious adverse events (number)	None of the trials reported this outcome.
Health‐related quality of life (30 days, 3 months)	None of the trials reported this outcome.
Health‐related quality of life (maximal follow‐up)	None of the trials reported this outcome.
The basis for the assumed risk* is the mean control group proportion. The corresponding risk (and its 95% credible interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CrI). Network meta‐analysis was not performed for any of the outcomes since there were only two treatments. CrI: credible intervals; OR: odds ratio.
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Risk of bias was unclear or high in the trial(s) (downgraded by 1 point). ² Sample size was low (total number of participants fewer than 400 for continuous outcomes and fewer than 300 events in total in both groups for other outcomes) (downgraded by 1 point). ³ Credible intervals spanned no effect and clinically significant effect (20% relative risk reduction for binary outcomes; standardised mean difference of 0.5 for health‐related quality of life) (downgraded by 1 point).

Table 14. Detailed 'Summary of findings' table: anterior approach vs conventional approach

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Table 15. Detailed 'Summary of findings' table: autologous blood donation vs control

Outcomes	*Illustrative comparative risks (95% CrI)**		Relative effect (95% CrI)	No of participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Intervention
Mortality (perioperative)	There was no mortality in either group.			28 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Mortality (longest follow‐up): reported at 1 year	There was no mortality in either group.			28 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Serious adverse events (proportion)	None of the trials reported this outcome.
Serious adverse events (number)	None of the trials reported this outcome.
Health‐related quality of life (30 days, 3 months)	None of the trials reported this outcome.
Health‐related quality of life (longest follow‐up)	None of the trials reported this outcome.
The basis for the assumed risk* is the mean control group proportion. The corresponding risk (and its 95% credible interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CrI). Network meta‐analysis was not performed for any of the outcomes since there were only two treatments. CrI: credible intervals; OR: odds ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Risk of bias was unclear or high in the trial(s) (downgraded by 1 point). ² Sample size was low (total number of participants fewer than 400 for continuous outcomes and fewer than 300 events in total in both groups for other outcomes) (downgraded by 1 point). ³Credible intervals spanned no effect and clinically significant effect (20% relative risk reduction for binary outcomes; standardised mean difference of 0.5 for health‐related quality of life) (downgraded by 1 point).

Table 15. Detailed 'Summary of findings' table: autologous blood donation vs control

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Table 16. Detailed 'Summary of findings' table: cardiopulmonary interventions

Outcomes	*Illustrative comparative risks (95% CrI)**		Relative effect (95% CrI)	No of participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Intervention
Mortality (perioperative)
Hypoventilation vs control	There was no mortality in either group.			79 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Low central venous pressure vs control	There was no mortality in either group.			85 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Mortality (longest follow‐up)	None of the trials reported this outcome.
Serious adverse events (proportion)
Hypoventilation vs control	26 per 1000	60 per 1000 (5 to 679)	OR 2.41 (0.18 to 80.4)	79 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Low central venous pressure vs acute normovolemic haemodilution plus low CVP	302 per 1000	284 per 1000 (157 to 460)	OR 0.92 (0.43 to 1.97)	63 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Serious adverse events (number)
Low central venous pressure vs control	100 per 1000	0 per 1000 (0 to 2)	Rate ratio 0.00 (0 to 0.02)	42 (1 study)	⊕⊝⊝⊝ Very low^a,b,c
Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	103 per 1000	77 per 1000 (15 to 287)	Rate ratio 0.73 (0.13 to 3.53)	78 (1 study)	⊕⊝⊝⊝ Very low^a,b,c
Health‐related quality of life (30 days, 3 months)	None of the trials reported this outcome.
Health‐related quality of life (longest follow‐up)	None of the trials reported this outcome.
The basis for the assumed risk* is the mean control group proportion. The corresponding risk (and its 95% credible interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CrI). Network meta‐analysis was not performed for any of the outcomes because of the lack of availability of direct and indirect comparisons in the network. CrI: credible intervals; OR: odds ratio.
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
^1aRisk of bias was unclear or high in the trial(s) (downgraded by 1 point). ² Sample size was low (total number of participants fewer than 400 for continuous outcomes and fewer than 300 events in total in both groups for other outcomes) (downgraded by 1 point). ³Credible intervals spanned no effect and clinically significant effect (20% relative risk reduction for binary outcomes; standardised mean difference of 0.5 for health‐related quality of life) (downgraded by 1 point).

Table 16. Detailed 'Summary of findings' table: cardiopulmonary interventions

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Table 17. Detailed 'Summary of findings' table: methods of parenchymal transection

Outcomes

Illustrative comparative risks* (95% CrI)

Relative effect (95% CrI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

Intervention

Mortality (perioperative)

CUSA vs clamp‐crush method

23 per 1000

6 per 1000

(0 to 54)

OR 0.24

(0.01 to 2.41)

172

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs clamp‐crush method

10 per 1000

16 per 1000

(4 to 65)

OR 1.60

(0.43 to 6.7)

390

(5 studies)

⊕⊝⊝⊝

Very low^1,2,3

Sharp transection method vs clamp‐crush method

There was no mortality in either group.

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Stapler vs clamp‐crush method

31 per 1000

67 per 1000

(12 to 375)

OR 2.26

(0.39 to 18.93)

130

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Hydrojet vs CUSA

55 per 1000

54 per 1000

(9 to 258)

OR 0.98

(0.16 to 6.04)

111

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs CUSA

44 per 1000

28 per 1000

(3 to 166)

OR 0.61

(0.07 to 4.28)

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Stapler vs CUSA

There was no mortality in either group.

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs hydrojet

80 per 1000

9 per 1000

(0 to 145)

OR 0.10

(0 to 1.95)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Mortality (longest follow‐up)

None of the trials reported this outcome.

Serious adverse events (proportion)

CUSA vs clamp‐crush method

93 per 1000

31 per 1000

(6 to 110)

OR 0.31

(0.06 to 1.2)

172

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs clamp‐crush method

58 per 1000

49 per 1000

(15 to 145)

OR 0.83

(0.24 to 2.74)

240

(3 studies)

⊕⊝⊝⊝

Very low^1,2,3

Sharp transection method vs clamp‐crush method

49 per 1000

106 per 1000

(20 to 502)

OR 2.31

(0.39 to 19.69)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Hydrojet vs CUSA

100 per 1000

124 per 1000

(61 to 238)

OR 1.27

(0.58 to 2.81)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs CUSA

50 per 1000

30 per 1000

(3 to 180)

OR 0.58

(0.06 to 4.16)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Stapler vs CUSA

246 per 1000

(6 to 931)

OR 1.00

(0.02 to 41.22)

130

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Serious adverse events (number)

CUSA vs clamp‐crush method

45 per 1000

29 per 1000

(3 to 166)

Rate ratio 0.63

(0.07 to 4.17)

132

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs clamp‐crush method

61 per 1000

190 per 1000

(75 to 474)

Rate ratio 3.64

(1.25 to 13.97)

130

(2 studies)

⊕⊕⊝⊝

Low^1,2

Hydrojet vs CUSA

80 per 1000

121 per 1000

(20 to 546)

Rate ratio 1.59

(0.24 to 13.83)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs CUSA

80 per 1000

121 per 1000

(20 to 546)

Rate ratio 1.59

(0.24 to 13.83)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Stapler vs CUSA

180 per 1000

230 per 1000

(109 to 424)

Rate ratio 1.36

(0.56 to 3.36)

100

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Radiofrequency dissecting sealer vs hydrojet

120 per 1000

(23 to 445)

Rate ratio 1.00

(0.17 to 5.88)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Health‐related quality of life (30 days, 3 months)

None of the trials reported this outcome.

Health‐related quality of life (maximal follow‐up)

None of the trials reported this outcome.

*The basis for the assumed risk is the mean control group proportion. The corresponding risk (and its 95% credible interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CrI).

Network meta‐analysis was not performed for any of the outcomes because of the lack of availability of direct and indirect comparisons in the network.

CrI: credible intervals; CUSA: cavitron ultrasonic surgical aspirator; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

¹ Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
² Sample size was low (total number of participants fewer than 400 for continuous outcomes and fewer than 300 events in total in both groups for other outcomes) (downgraded by 1 point).
³ Credible intervals spanned no effect and clinically significant effect (20% relative risk reduction for binary outcomes; standardised mean difference of 0.5 for health‐related quality of life) (downgraded by 1 point).

Table 17. Detailed 'Summary of findings' table: methods of parenchymal transection

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Table 18. Detailed 'Summary of findings' Table: methods of dealing with cut surface

Outcomes

Illustrative comparative risks* (95% CrI)

Relative effect (95% CrI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

Intervention

Mortality (perioperative)

Fibrin sealant vs control

11 per 1000

41 per 1000

(10 to 253)

OR 4.03

(0.9 to 31.72)

380

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant and collagen vs control

13 per 1000

45 per 1000

(10 to 268)

OR 3.48

(0.74 to 27.03)

300

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant vs argon beam

53 per 1000

72 per 1000

(25 to 198)

OR 1.39

(0.46 to 4.45)

227

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant vs collagen

33 per 1000

30 per 1000

(7 to 123)

OR 0.91

(0.2 to 4.14)

256

(3 studies)

⊕⊝⊝⊝

Very low^1,2,3

Oxidised cellulose vs fibrin sealant

56 per 1000

31 per 1000

(1 to 565)

OR 0.54

(0.01 to 22.09)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Plasmajet vs fibrin sealant

103 per 1000

65 per 1000

(7 to 332)

OR 0.60

(0.06 to 4.31)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Mortality (longest follow‐up)

None of the trials reported this outcome.

Serious adverse events (proportion)

Fibrin sealant vs control

186 per 1000

191 per 1000

(128 to 275)

OR 1.03

(0.64 to 1.66)

457

(3 studies)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant vs argon beam

269 per 1000

183 per 1000

(78 to 360)

OR 0.61

(0.23 to 1.53)

106

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant vs collagen

258 per 1000

356 per 1000

(205 to 547)

OR 1.59

(0.74 to 3.47)

127

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Oxidised cellulose vs fibrin sealant

444 per 1000

309 per 1000

(113 to 603)

OR 0.56

(0.16 to 1.9)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Plasmajet vs fibrin sealant

207 per 1000

25 per 1000

(0 to 165)

OR 0.10

(0 to 0.76)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Serious adverse events (number)

Fibrin sealant vs control

486 per 1000

470 per 1000

(307 to 640)

Rate ratio 0.94

(0.47 to 1.88)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant & collagen vs control

147 per 1000

186 per 1000

(116 to 286)

Rate ratio 1.33

(0.76 to 2.33)

300

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant vs argon beam

65 per 1000

249 per 1000

(107 to 547)

Rate ratio 4.81

(1.73 to 17.5)

121

(1 study)

⊕⊕⊝⊝

Low^1,2

Fibrin sealant vs collagen

323 per 1000

369 per 1000

(266 to 488)

Rate ratio 1.23

(0.76 to 2)

189

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Fibrin sealant vs cyanoacrylate

67 per 1000

(2 to 733)

Rate ratio 1.01

(0.03 to 38.36)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Oxidised cellulose vs cyanoacrylate

67 per 1000

277 per 1000

(46 to 921)

Rate ratio 5.37

(0.67 to 163.2)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Oxidised cellulose vs fibrin sealant

67 per 1000

278 per 1000

(46 to 926)

Rate ratio 5.40

(0.67 to 174.86)

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Health‐related quality of life (30 days, 3 months)

None of the trials reported this outcome.

Health‐related quality of life (longest follow‐up)

None of the trials reported this outcome.

Network meta‐analysis was not performed for any of the outcomes because of the lack of availability of direct and indirect comparisons in the network.

CrI: credible intervals; OR: odds ratio.

¹ Risk of bias was unclear or high in the trial(s) (downgraded by 1 point).
² Sample size was low (total number of participants fewer than 400 for continuous outcomes and fewer than 300 events in total in both groups for other outcomes) (downgraded by 1 point).
³Credible intervals spanned no effect and clinically significant effect (20% relative risk reduction for binary outcomes; standardised mean difference of 0.5 for health‐related quality of life) (downgraded by 1 point).

Table 18. Detailed 'Summary of findings' Table: methods of dealing with cut surface

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Table 19. Detailed 'Summary of findings' table: methods of vascular occlusion

Outcomes

Illustrative comparative risks* (95% CrI)

Relative effect (95% CrI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

Intervention

Mortality (perioperative)

Continuous portal triad clamping vs control

There was no mortality in either group.

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs control

26 per 1000

15 per 1000

(3 to 60)

OR 0.60

(0.13 to 2.42)

392

(4 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous portal triad clamping vs continuous hepatic vascular exclusion

1 per 1000

5 per 1000

(4 to 15)

OR 4.91

(3.68 to 15.64)

170

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective hepatic vascular exclusion vs continuous portal triad clamping

There was no mortality in either group.

160

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective portal triad clamping vs continuous portal triad clamping

There was no mortality in either group.

120

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs continuous portal triad clamping

67 per 1000

10 per 1000

(0 to 70)

OR 0.14

(0 to 1.05)

121

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs continuous selective portal triad clamping

There was no mortality in either group.

(1 study)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent selective portal triad clamping vs intermittent portal triad clamping

1 per 1000

2 per 1000

(0 to 69)

OR 2.27

(0.17 to 74)

138

(2 studies)

⊕⊝⊝⊝

Very low^1,2,3

Mortality (longest follow‐up)

None of the trials reported this outcome.

Serious adverse events (proportion)*

Continuous hepatic vascular exclusion vs control

99 per 1000

200 per 1000

(19 to 785)

Rate ratio 2.27

(0.18 to 33.05)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous portal triad clamping vs control

99 per 1000

135 per 1000

(30 to 439)

Rate ratio 1.42

(0.28 to 7.09)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective hepatic vascular exclusion vs control

99 per 1000

15 per 1000

(0 to 325)

Rate ratio 0.14

(0 to 4.37)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective portal triad clamping vs control

99 per 1000

55 per 1000

(11 to 226)

Rate ratio 0.53

(0.1 to 2.65)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs control

99 per 1000

113 per 1000

(56 to 217)

Rate ratio 1.16

(0.54 to 2.51)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous portal triad clamping vs continuous hepatic vascular exclusion

50 per 1000

32 per 1000

(2 to 412)

Rate ratio 0.63

(0.03 to 13.31)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective hepatic vascular exclusion vs continuous hepatic vascular exclusion

50 per 1000

3 per 1000

(0 to 442)

Rate ratio 0.06

(0 to 15.06)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective portal triad clamping vs continuous hepatic vascular exclusion

50 per 1000

12 per 1000

(1 to 209)

Rate ratio 0.23

(0.01 to 5.02)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs continuous hepatic vascular exclusion

50 per 1000

26 per 1000

(2 to 288)

Rate ratio 0.51

(0.03 to 7.68)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective hepatic vascular exclusion vs continuous portal triad clamping

139 per 1000

16 per 1000

(0 to 724)

Rate ratio 0.10

(0 to 16.28)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective portal triad clamping vs continuous portal triad clamping

139 per 1000

56 per 1000

(6 to 374)

Rate ratio 0.37

(0.04 to 3.7)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs continuous portal triad clamping

139 per 1000

117 per 1000

(22 to 439)

Rate ratio 0.82

(0.14 to 4.86)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Continuous selective portal triad clamping vs continuous selective hepatic vascular exclusion

As there were no serious adverse events in either group, the credible intervals were extremely wide. This is equivalent to not estimable in direct comparisons.

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs continuous selective hepatic vascular exclusion

As there were no serious adverse events in either group, the credible intervals were extremely wide. This is equivalent to not estimable in direct comparisons.

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Intermittent portal triad clamping vs continuous selective portal triad clamping

130 per 1000

247 per 1000

(51 to 665)

Rate ratio 2.19

(0.36 to 13.26)

815

(6 studies)

⊕⊝⊝⊝

Very low^1,2,3

Serious adverse events (number)

Intermittent portal triad clamping vs control

80 per 1000

119 per 1000

(36 to 358)

Rate ratio 1.55

(0.43 to 6.4)

100

(1 study)

⊕⊝⊝⊝

Very low^a,b,c

Continuous portal triad clamping vs continuous hepatic vascular exclusion

179 per 1000

36 per 1000

(2 to 218)

Rate ratio 0.17

(0.01 to 1.28)

(1 study)

⊕⊝⊝⊝

Very low^a,b,c

Intermittent portal triad clamping vs continuous portal triad clamping

190 per 1000

21 per 1000

(0 to 116)

Rate ratio 0.09

(0 to 0.56)

(1 study)

⊕⊕⊝⊝

Low^a,b

Intermittent selective portal triad clamping vs intermittent portal triad clamping

134 per 1000

165 per 1000

(76 to 328)

Rate ratio 1.27

(0.53 to 3.15)

138

(2 studies)

⊕⊝⊝⊝

Very low^a,b,c

Health‐related quality of life (30 days, 3 months)

None of the trials reported this outcome.

Health‐related quality of life (longest follow‐up)

None of the trials reported this outcome.

Network meta‐analysis was not performed for any of the outcomes other than serious adverse events (proportion) because of the lack of availability of direct and indirect comparisons in the network.

CrI: credible intervals; OR: odds ratio.

Table 19. Detailed 'Summary of findings' table: methods of vascular occlusion

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Table 20. Detailed 'Summary of findings' table: pharmacological interventions

Outcomes	*Illustrative comparative risks (95% CrI)**		Relative effect (95% CrI)	No of participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Intervention
Mortality (perioperative)
Recombinant factor VIIa vs control	51 per 1000	33 per 1000 (7 to 158)	OR 0.63 (0.13 to 3.51)	185 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Tranexamic acid vs control	There was no mortality in either group.			214 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Mortality (longest follow‐up)	None of the trials reported this outcome.
Serious adverse events (proportion)
Anti‐thrombin III vs control	273 per 1000	312 per 1000 (67 to 761)	OR 1.21 (0.19 to 8.49)	24 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Recombinant Factor VIIa vs control	376 per 1000	396 per 1000 (256 to 555)	OR 1.09 (0.57 to 2.07)	432 (2 studies)	⊕⊝⊝⊝ Very low^1,2,3
Serious adverse events (number)
Recombinant Factor VIIa vs control	81 per 1000	120 per 1000 (68 to 217)	Rate ratio 1.55 (0.83 to 3.16)	432 (2 studies)	⊕⊝⊝⊝ Very low^1,2,3
Tranexamic acid vs control	75 per 1000	65 per 1000 (23 to 164)	Rate ratio 0.85 (0.29 to 2.41)	214 (1 study)	⊕⊝⊝⊝ Very low^1,2,3
Health‐related quality of life (30 days, 3 months)	None of the trials reported this outcome.
Health‐related quality of life (maximal follow‐up)	None of the trials reported this outcome.
The basis for the assumed risk* is the mean control group proportion. The corresponding risk (and its 95% credible interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CrI). Network meta‐analysis was not performed for any of the outcomes because of the lack of availability of direct and indirect comparisons in the network. CrI: credible intervals; OR: odds ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Risk of bias was unclear or high in the trial(s) (downgraded by 1 point). ² Sample size was low (total number of participants fewer than 400 for continuous outcomes and fewer than 300 events in total in both groups for other outcomes) (downgraded by 1 point). ³ Credible intervals spanned no effect and clinically significant effect (20% relative risk reduction for binary outcomes; standardised mean difference of 0.5 for health‐related quality of life) (downgraded by 1 point).

Table 20. Detailed 'Summary of findings' table: pharmacological interventions

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Table 1. Different methods of cardiopulmonary interventions

Acute normovolemic haemodilution (ANH)

Low central venous pressure (central venous pressure)

Hypoventilation

Combination of ANH with central venous pressure or hypotension

Table 1. Different methods of cardiopulmonary interventions

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Table 2. Different methods of parenchymal transection

Finger‐fracture method

Clamp‐crush method

Cavitron ultrasonic surgical aspirator

Sharp dissection

Radiofrequency dissecting sealer

Ultrasonic shears

Stapler

Waterjet (Hydrojet)

Table 2. Different methods of parenchymal transection

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Table 3. Different methods of dealing with raw surface

Suturing for large and medium vessels and ducts and performing electrocauterisation of small vessels and ducts

Suturing for large vessels and performing ultrasonic shears for medium‐sized and small vessels and ducts

Suturing and argon beam coagulator

Suturing and fibrin sealant

Suturing and collagen

Suturing and oxidised cellulose

Suturing and cyanoacrylate

Suturing and combination of fibrin sealant with collagen or oxidised cellulose

Table 3. Different methods of dealing with raw surface

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Table 4. Different methods of vascular occlusion

No vascular occlusion

Portal triad clamping (continuous) (occlusion of inflow alone)

Portal triad clamping (intermittent) (occlusion of inflow alone)

Hepatic vascular exclusion (occlusion of inflow and outflow) (continuous or intermittent)

Selective portal trial clamping (occlusion of inflow to the hemi‐liver that is being resected) (continuous or intermittent)

Selective hepatic vascular exclusion (occlusion of inflow to the hemi‐liver and outflow from the hemi‐liver that is being resected) (continuous or intermittent)

Table 4. Different methods of vascular occlusion

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Table 5. Clavien‐Dindo classification of postoperative complications

Grades	Definitions	Examples
I	Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, or radiological interventions	Drugs such as antiemetics, antipyretics, analgesics, diuretics, and electrolytes; physiotherapy; wound infections opened at the bedside
II	Requiring pharmacological treatment with drugs other than those allowed for grade I complications	Blood transfusions, total parenteral nutrition
III	Requiring surgical, endoscopic, or radiological intervention	Bile leak requiring endoscopic stent; re‐operation for any cause; drainage of infected intra‐abdominal collection
IV	Life‐threatening complication requiring high dependency or intensive care management	Dialysis
V	Death of patient	—
Suffix d	If the patient suffers from a complication at the time of discharge and needs further follow‐up to evaluate the complication fully	—
Adapted from Dindo 2004; Clavien 2009.

Table 5. Clavien‐Dindo classification of postoperative complications

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Table 6. Cardiopulmonary interventions: choice of model results

Blood transfusion (red blood cell) (units)
Treatment number	Treatment name
1	Control
2	Acute normovolemic haemodilution
3	Acute normovolemic haemodilution plus hypotension
4	Acute normovolemic haemodilution plus low central venous pressure
5	Low central venous pressure
	Fixed‐effect model	Random‐effects model	Inconsistency model
Dbar^a	2.68	−8.90	−9.80
pD^b	10.05	12.67	11.96
DIC^c	12.73	3.77	2.17
d[2]^d	−1.23 (95% CrI −1.74 to −0.73)	−1.26 (95% CrI −4.92 to 2.39)	—
d[3]^e	−1.65 (95% CrI −2.06 to −1.25)	−1.68 (95% CrI −5.33 to 1.98)	—
d[4]^f	0.15 (95% CrI −0.10 to 0.40)	−0.57 (95% CrI −3.35 to 1.88)	—
d[5]^g	−0.81 (95% CrI −1.33 to −0.30)	−1.08 (95% CrI −3.43 to 1.13)	—
Between‐study standard deviation	—	1.446
Model used	Random‐effects model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
Blood loss (litres)
Treatment number	Treatment name
1	Control
2	Acute normovolemic haemodilution
3	Acute normovolemic haemodilution plus hypotension
4	Acute normovolemic haemodilution plus low central venous pressure
5	Hypoventilation
6	Low central venous pressure
	Fixed‐effect model	Random‐effects model	Inconsistency model
Dbar^a	−24.73	−36.06	−36.65
pD^b	14.00	17.77	18.26
DIC^c	−10.73	−18.29	−18.39
d[2]^d	0.00 (95% CrI −0.10 to 0.10)	0.00 (95% CrI −0.95 to 0.96)	—
d[3]^e	−0.25 (95% CrI −0.37 to −0.13)	−0.25 (95% CrI −1.20 to 0.71)	—
d[4]^f	0.01 (95% CrI −0.04 to 0.07)	−0.10 (95% CrI −0.88 to 0.46)	—
d[5]^g	0.00 (95% CrI −1.12 to 1.12)	−0.01 (95% CrI −1.44 to 1.43)	—
d[6]^h	−0.29 (95% CrI −0.40 to −0.18)	−0.32 (95% CrI −0.86 to 0.09)	—
Between‐study standard deviation	—	0.3734	—
Model used	Random‐effects model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
^aDbar = posterior mean of deviance. ^bpD = effective number of parameters. ^cDIC = deviance information criterion. ^dd[2] indicates effect estimate (mean difference) of treatment 2 versus treatment 1. ^ed[3] indicates effect estimate (mean difference) of treatment 3 versus treatment 1. ^fd[4] indicates effect estimate (mean difference) of treatment 4 versus treatment 1. ^gd[5] indicates effect estimate (mean difference) of treatment 5 versus treatment 1. ^hd[6] indicates effect estimate (mean difference) of treatment 6 versus treatment 1.

Table 6. Cardiopulmonary interventions: choice of model results

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Table 7. Parenchymal transection methods: choice of model results

Adverse events (proportion)
Treatment number	Treatment name
1	Clamp‐crush method
2	Cavitron ultrasonic surgical aspirator
3	Hydrojet
4	Radiofrequency dissecting sealer
5	Sharp transection method
6	Stapler
	Fixed‐effect model	Random‐effects model	Inconsistency model*
Dbar^a	95.62	80.26	81.67
pD^b	13.05	17.04	16.71
DIC^c	108.67	97.30	98.37
d[2]^d	0.32 (95% CrI −0.28 to 0.92)	0.76 (95% CrI −2.18 to 4.69)	—
d[3]^e	−0.99 (95% CrI −2.76 to 0.54)	−0.56 (95% CrI −6.84 to 6.60)	—
d[4]^f	0.11 (95% CrI −0.46 to 0.68)	0.19 (95% CrI −2.95 to 3.50)	—
d[5]^g	0.10 (95% CrI −0.79 to 1.00)	0.1 (95% CrI −5.59 to 5.80)	—
d[6]^h	0.06 (95% CrI −0.63 to 0.76)	0.06 (95% CrI −5.59 to 5.76)	—
Between‐study standard deviation	—	2.436	—
Model used	Random‐effects model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
Adverse events (number)
Treatment number	Treatment name
1	Clamp‐crush method
2	Cavitron ultrasonic surgical aspirator
3	Hydrojet
4	Radiofrequency dissecting sealer
5	Sharp transection method
6	Stapler
	Fixed‐effect model	Random‐effects model	Inconsistency model*
Dbar^a	80.99	80.94	79.59
pD^b	11.93	11.88	14.76
DIC^c	92.92	92.83	94.35
d[2]^d	0.47 (95% CrI −0.08 to 1.03)	0.47 (95% CrI −0.08 to 1.03)	—
d[3]^e	0.34 (95% CrI −0.71 to 1.29)	0.33 (95% CrI −0.71 to 1.28)	—
d[4]^f	0.61 (95% CrI 0.12 to 1.12)	0.61 (95% CrI 0.12 to 1.11)	—
d[5]^g	0.12 (95% CrI −0.56 to 0.81)	0.12 (95% CrI −0.56 to 0.81)	—
d[6]^h	0.62 (95% CrI −0.21 to 1.48)	0.62 (95% CrI −0.20 to 1.45)	—
Between‐study standard deviation	—	2.499	—
Model used	Fixed‐effect model		—
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
Blood transfusion (proportion)
Treatment number	Treatment name
1	Clamp‐crush method
2	Cavitron ultrasonic surgical aspirator
3	Hydrojet
4	Radiofrequency dissecting sealer
5	Sharp transection method
	Fixed‐effect model	Random‐effects model	Inconsistency model*
Dbar^a	72.41	71.86	72.23
pD^b	11.91	13.99	14.98
DIC^c	84.33	85.85	87.21
d[2]^d	0.39 (95% CrI −0.62 to 1.42)	0.42 (95% CrI −1.09 to 1.96)	—
d[3]^e	0.55 (95% CrI −0.75 to 1.83)	0.60 (95% CrI −1.47 to 2.83)	—
d[4]^f	0.09 (95% CrI −0.50 to 0.68)	0.14 (95% CrI −0.77 to 1.32)	—
d[5]^g	−0.22 (95% CrI −1.16 to 0.71)	−0.22 (95% CrI −2.21 to 1.75)	—
Between‐study standard deviation	—	0.6464	—
Model used	Fixed‐effect model		—
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
^aDBar = posterior mean of deviance. ^bpD = effective number of parameters. ^cDIC = deviance information criterion. ^dd[2] indicates log transformed effect estimate (odds ratio or rate ratio) of treatment 2 versus treatment 1. ^ed[3] indicates log transformed effect estimate (odds ratio or rate ratio) of treatment 3 versus treatment 1. ^fd[4] indicates log transformed effect estimate (odds ratio or rate ratio) of treatment 4 versus treatment 1. ^gd[5] indicates log transformed effect estimate (odds ratio or rate ratio) of treatment 5 versus treatment 1. ^hd[6] indicates log transformed effect estimate (odds ratio or rate ratio) of treatment 6 versus treatment 1.

Table 7. Parenchymal transection methods: choice of model results

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Table 8. Vascular occlusion methods: choice of model results

Serious adverse events (proportion)
Treatment number	Treatment name
1	Control
2	ConHVE
3	ConPTC
4	ConSelectiveHVE
5	ConSelectivePTC
6	IntPTC
	Fixed‐effect model	Random‐effects model	Inconsistency model
Dbar^a	64.25	63.57	64.03
pD^b	12.54	14.37	14.83
DIC^c	76.79	77.95	78.86
d[2]^d	0.82 (95% CrI −1.70 to 3.50)	0.62 (95% CrI −5.00 to 5.89)	—
d[3]^e	0.35 (95% CrI −1.26 to 1.96)	0.16 (95% CrI −3.87 to 3.71)	—
d[4]^f	−1.98 (95% CrI −8.24 to 1.48)	−2.25 (95% CrI −9.99 to 3.38)	—
d[5]^g	−0.63 (95% CrI −2.29 to 0.97)	−1.01 (95% CrI −5.35 to 2.36)	—
d[6]^h	0.15 (95% CrI −0.61 to 0.92)	−0.07 (95% CrI −2.53 to 1.85)	—
Between‐study standard deviation	—	1.216	—
Model used	Fixed‐effect model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.

Adverse events (proportion)
Treatment number	Treatment name
1	Control
2	ConHVE
3	ConPTC
4	ConSelectiveHVE
5	ConSelectivePTC
6	IntPTC
7	IntSelectivePTC
	Fixed‐effect model	Random‐effects model	Inconsistency model
Dbar^a	120.82	118.76	119.07
pD^b	18.10	21.01	21.93
DIC^c	138.92	139.77	141.00
d[2]^d	0.95 (95% CrI −0.21 to 2.12)	0.90 (95% CrI −1.12 to 2.84)	—
d[3]^e	0.83 (95% CrI 0.00 to 1.69)	0.78 (95% CrI −0.58 to 2.09)	—
d[4]^f	0.05 (95% CrI −1.19 to 1.27)	0.00 (95% CrI −2.05 to 1.96)	—
d[5]^g	0.10 (95% CrI −0.81 to 1.01)	0.07 (95% CrI −1.42 to 1.50)	—
d[6]^h	0.24 (95% CrI −0.19 to 0.68)	0.18 (95% CrI −0.66 to 0.88)	—
d[7]ⁱ	0.09 (95% CrI −0.75 to 0.93)	0.04 (95% CrI −1.37 to 1.35)	—
Between‐study standard deviation	—	0.4825	—
Model used	Fixed‐effect model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
Blood transfusion (proportion)
Treatment number	Treatment name
1	Control
2	ConHVE
3	ConPTC
4	ConSelectiveHVE
5	ConSelectivePTC
6	IntPTC
7	IntSelectivePTC
	Fixed‐effect model	Random‐effects model	Inconsistency model
Dbar^a	139.87	120.00	120.10
pD^b	19.04	25.25	25.72
DIC^c	158.91	145.25	145.82
d[2]^d	−2.55 (95% CrI −3.80 to −1.36)	−2.88 (95% CrI −7.47 to 1.47)	—
d[3]^e	−0.77 (95% CrI −1.56 to 0.01)	−1.11 (95% CrI −3.72 to 1.28)	—
d[4]^f	−1.46 (95% CrI −2.58 to −0.36)	−1.79 (95% CrI −6.38 to 2.53)	—
d[5]^g	−0.26 (95% CrI −1.18 to 0.67)	−0.48 (95% CrI −3.83 to 2.72)	—
d[6]^h	−0.34 (95% CrI −0.84 to 0.16)	−0.47 (95% CrI −2.32 to 1.28)	—
d[7]ⁱ	−0.92 (95% CrI −1.96 to 0.08)	−0.97 (95% CrI −4.24 to 2.24)	—
Between study standard deviation	—	1.613	—
Model used	Random‐effects model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
Blood transfusion (red blood cell) (units)
Treatment number	Treatment name
1	Control
2	ConHVE
3	ConPTC
4	ConSelectiveHVE
5	ConSelectivePTC
6	IntPTC
7	IntSelectivePTC
	Fixed‐effect model	Random‐effects model	Inconsistency model
Dbar^a	−1.55	−1.05	0.24
pD^b	15.99	17.36	19.34
DIC^c	14.44	16.32	19.58
d[2]^d	−1.65 (95% CrI −3.96 to 0.67)	−1.56 (95% CrI −4.18 to 1.14)	—
d[3]^e	−1.25 (95% CrI −2.39 to −0.10)	−1.18 (95% CrI −2.54 to 0.31)	—
d[4]^f	−2.45 (95% CrI −4.08 to −0.82)	−2.37 (95% CrI −4.33 to −0.30)	—
d[5]^g	−1.45 (95% CrI −2.59 to −0.31)	−1.41 (95% CrI −2.86 to 0.12)	—
d[6]^h	−1.36 (95% CrI −2.48 to −0.23)	−1.35 (95% CrI −2.69 to 0.01)	—
d[7]ⁱ	−1.43 (95% CrI −2.61 to −0.24)	−1.43 (95% CrI −3.01 to 0.08)	—
Between‐study standard deviation	—	0.3149	—
Model used	Fixed‐effect model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
Blood loss (litres)
Treatment number	Treatment name
1	Control
2	ConHVE
3	ConPTC
4	ConSelectiveHVE
5	ConSelectivePTC
6	IntPTC
7	IntSelectivePTC
	Fixed‐effect model	Random‐effects model	Inconsistency model
Dbar^a	−45.73	−61.66	−63.13
pD^b	22.01	29.37	30.58
DIC^c	−23.72	−32.29	−32.55
d[2]^d	−0.36 (95% CrI −0.50 to −0.23)	−0.37 (95% CrI −0.94 to 0.22)	—
d[3]^e	−0.02 (95% CrI −0.12 to 0.07)	−0.14 (95% CrI −0.52 to 0.14)	—
d[4]^f	−0.27 (95% CrI −0.54 to −0.01)	−0.39 (95% CrI −1.16 to 0.27)	—
d[5]^g	0.09 (95% CrI −0.04 to 0.21)	0.00 (95% CrI −0.57 to 0.45)	—
d[6]^h	0.01 (95% CrI −0.05 to 0.07)	−0.06 (95% CrI −0.39 to 0.17)	—
d[7]ⁱ	0.00 (95% CrI −0.21 to 0.2)	−0.18 (95% CrI −0.84 to 0.30)	—
Between‐study standard deviation	—	0.2539	—
Model used	Random‐effects model
Evidence of inconsistency	There is no evidence of inconsistency since the difference in DIC between consistency and inconsistency models was not significant.
Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping.
^aDBar = posterior mean of deviance. ^bpD = effective number of parameters. ^cDIC = deviance information criterion. ^dd[2] indicates effect estimate (mean difference) of treatment 2 versus treatment 1. ^ed[3] indicates effect estimate (mean difference) of treatment 3 versus treatment 1. ^fd[4] indicates effect estimate (mean difference) of treatment 4 versus treatment 1. ^gd[5] indicates effect estimate (mean difference) of treatment 5 versus treatment 1. ^hd[6] indicates effect estimate (mean difference) of treatment 6 versus treatment 1. ⁱd[7] indicates effect estimate (mean difference) of treatment 7 versus treatment 1.

Table 8. Vascular occlusion methods: choice of model results

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Table 9. Cardiopulmonary interventions: pair‐wise comparisonsa,b

Blood transfusion (red blood cell) (units)
	Acute normovolemic haemodilution	Acute normovolemic haemodilution plus hypotension	Acute normovolemic haemodilution plus low central venous pressure	Low central venous pressure
Control	MD −1.26; 95% CrI −4.92 to 2.39	MD −1.68; 95% CrI −5.33 to 1.98	MD −0.57; 95% CrI −3.35 to 1.88	MD −1.08; 95% CrI −3.43 to 1.13
Acute normovolemic haemodilution	—	MD −0.42; 95% CrI −5.59 to 4.75	MD 0.69; 95% CrI −3.80 to 5.18	MD 0.18; 95% CrI −4.12 to 4.49
Acute normovolemic haemodilution plus hypotension	—	—	MD 1.11; 95% CrI −3.39 to 5.60	MD 0.60; 95% CrI −3.71 to 4.91
Acute normovolemic haemodilution plus low central venous pressure	—	—	—	MD −0.51; 95% CrI −3.97 to 2.96
Blood loss (litres)
	Acute normovolemic haemodilution	Acute normovolemic haemodilution plus hypotension	Acute normovolemic haemodilution plus low central venous pressure	Hypoventilation
Control	MD 0.00; 95% CrI −0.95 to 0.96	MD −0.25; 95% CrI −1.20 to 0.71	MD −0.10; 95% CrI −0.88 to 0.46	MD −0.01; 95% CrI −1.44 to 1.43
Acute normovolemic haemodilution	—	MD −0.25; 95% CrI −1.60 to 1.10	MD −0.11; 95% CrI −1.27 to 1.06	MD −0.01; 95% CrI −1.73 to 1.71
Acute normovolemic haemodilution plus hypotension	—	—	MD 0.14; 95% CrI −1.02 to 1.31	MD 0.24; 95% CrI −1.48 to 1.96
Acute normovolemic haemodilution plus low central venous pressure	—	—	—	MD 0.10; 95% CrI −1.49 to 1.68
Hypoventilation	—	—	—	—
^aThe table provides the effect estimate of each pair‐wise comparison. To identify the effect estimate of a comparison (e.g. A versus B), look at the cell that occupies the column corresponding to treatment A and the row corresponding to treatment B. This gives the information directly. If that cell is empty (indicated by a '—', you have to look at column corresponding to treatment B and row corresponding to treatment A. You will have to take the inverse of this number (i.e. 1/number) to get the treatment effect. ^bTreatment effects with evidence of difference are shown by italics (not applicable).

Table 9. Cardiopulmonary interventions: pair‐wise comparisonsa,b

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Table 10. Parenchymal transection methods: pair‐wise comparisonsa,b

Adverse events (proportion)
	Cavitron ultrasonic surgical aspirator	Hydrojet	Radiofrequency dissecting sealer	Sharp transection method
Clamp‐crush method	OR 2.15; 95% CrI 0.11 to 108.74	OR 0.57; 95% CrI 0.00 to 732.89	OR 1.20; 95% CrI 0.05 to 33.05	OR 1.11; 95% CrI 0.00 to 331.29
Cavitron ultrasonic surgical aspirator	—	OR 0.27; 95% CrI 0.00 to 501.34	OR 0.56; 95% CrI 0.01 to 62.38	OR 0.52; 95% CrI 0.00 to 398.54
Hydrojet	—	—	OR 2.12; 95% CrI 0.00 to 3638.36	OR 1.94; 95% CrI 0.00 to 12959.09
Radiofrequency dissecting sealer	—	—	—	OR 0.92; 95% CrI 0.00 to 638.06
Sharp transection method	—	—	—	‐
Adverse events (number)
	Cavitron ultrasonic surgical aspirator	Hydrojet	Radiofrequency dissecting sealer	Sharp transection method
Clamp‐crush method	rate ratio 1.60; 95% CrI 0.92 to 2.79	rate ratio 1.40; 95% CrI 0.49 to 3.63	rate ratio 1.84; 95% CrI 1.13 to 3.06	rate ratio 1.13; 95% CrI 0.57 to 2.24
Cavitron ultrasonic surgical aspirator	—	rate ratio 0.88; 95% CrI 0.28 to 2.75	rate ratio 1.15; 95% CrI 0.54 to 2.42	rate ratio 0.71; 95% CrI 0.29 to 1.71
Hydrojet	—	—	rate ratio 1.31; 95% CrI 0.43 to 4.01	rate ratio 0.81; 95% CrI 0.24 to 2.71
Radiofrequency dissecting sealer	—	—	—	rate ratio 0.62; 95% CrI 0.26 to 1.44
Sharp transection method	—	—	—	—
Blood transfusion (proportion)
	Cavitron ultrasonic surgical aspirator	Hydrojet	Radiofrequency dissecting sealer	Sharp transection method
Clamp‐crush method	OR 1.48; 95% CrI 0.54 to 4.13	OR 1.73; 95% CrI 0.47 to 6.25	OR 1.09; 95% CrI 0.61 to 1.97	OR 0.80; 95% CrI 0.31 to 2.03
Cavitron ultrasonic surgical aspirator	—	OR 1.17; 95% CrI 0.23 to 6.05	OR 0.74; 95% CrI 0.23 to 2.39	OR 0.54; 95% CrI 0.14 to 2.15
Hydrojet	—	—	OR 0.63; 95% CrI 0.15 to 2.61	OR 0.46; 95% CrI 0.09 to 2.27
Radiofrequency dissecting sealer	—	—	—	OR 0.73; 95% CrI 0.24 to 2.21
^aThe table provides the effect estimate of each pair‐wise comparison. To identify the effect estimate of a comparison (e.g. A versus B), look at the cell that occupies the column corresponding to treatment A and the row corresponding to treatment B. This gives the information directly. If that cell is empty (indicated by a '—', you have to look at column corresponding to treatment B and row corresponding to treatment A. You will have to take the inverse of this number (i.e. 1/number) to get the treatment effect. ^bTreatment effects with evidence of difference are shown by italics (not applicable).

Table 10. Parenchymal transection methods: pair‐wise comparisonsa,b

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Table 11. Vascular occlusion methods: pair‐wise comparisonsa,b

Serious adverse events (proportion)
	ConHVE	ConPTC	ConSelectiveHVE	ConSelectivePTC	IntPTC
Control	OR 2.27; 95% CrI 0.18 to 33.05	OR 1.42; 95% CrI 0.28 to 7.09	OR 0.14; 95% CrI 0.00 to 4.37	OR 0.53; 95% CrI 0.10 to 2.65	OR 1.16; 95% CrI 0.54 to 2.51
ConHVE	—	OR 0.63; 95% CrI 0.03 to 13.31	OR 0.06; 95% CrI 0.00 to 15.06	OR 0.23; 95% CrI 0.01 to 5.02	OR 0.51; 95% CrI 0.03 to 7.68
ConPTC	—	—	OR 0.10; 95% CrI 0.00 to 16.28	OR 0.37; 95% CrI 0.04 to 3.70	OR 0.82; 95% CrI 0.14 to 4.86
ConSelectiveHVE	—	—	—	Not estimable	Not estimable
ConSelectivePTC	—	—	—	—	OR 2.19; 95% CrI 0.36 to 13.26
Adverse events (proportion)
	ConHVE	ConPTC	ConSelectiveHVE	ConSelectivePTC	IntPTC
Control	OR 2.58; 95% CrI 0.81 to 8.30	OR 2.30; 95% CrI 1.00 to 5.41	OR 1.06; 95% CrI 0.31 to 3.58	OR 1.11; 95% CrI 0.45 to 2.75	OR 1.28; 95% CrI 0.83 to 1.97
ConHVE	—	OR 0.89; 95% CrI 0.21 to 3.75	OR 0.41; 95% CrI 0.08 to 2.22	OR 0.43; 95% CrI 0.10 to 1.88	OR 0.49; 95% CrI 0.14 to 1.71
ConPTC	—	—	OR 0.46; 95% CrI 0.10 to 2.04	OR 0.48; 95% CrI 0.14 to 1.67	OR 0.55; 95% CrI 0.21 to 1.43
ConSelectiveHVE	—	—	—	OR 1.05; 95% CrI 0.23 to 4.84	OR 1.21; 95% CrI 0.33 to 4.45
ConSelectivePTC	—	—	—	—	OR 1.15; 95% CrI 0.42 to 3.16
IntPTC	—	—	—	—	—
Blood transfusion (proportion)
	ConHVE	ConPTC	ConSelectiveHVE	ConSelectivePTC	IntPTC
Control	OR 0.06; 95% CrI 0.00 to 4.33	OR 0.33; 95% CrI 0.02 to 3.59	OR 0.17; 95% CrI 0.00 to 12.59	OR 0.62; 95% CrI 0.02 to 15.18	OR 0.63; 95% CrI 0.10 to 3.59
ConHVE	—	Not estimable	Not estimable	Not estimable	Not estimable
ConPTC	—	—	OR 0.51; 95% CrI 0.00 to 83.52	Not estimable	OR 1.89; 95% CrI 0.09 to 41.17
ConSelectiveHVE	—	—	—	Not estimable	Not estimable
ConSelectivePTC	—	—	—	—	OR 1.01; 95% CrI 0.02 to 42.32
IntPTC	—	—	—	—	—
Blood transfusion (red blood cell)
	ConHVE	ConPTC	ConSelectiveHVE	ConSelectivePTC	IntPTC
Control	MD −1.65; 95% CrI −3.96 to 0.67	MD −1.25; 95% CrI −2.39 to −0.10	MD −2.45; 95% CrI −4.08 to −0.82	MD −1.45; 95% CrI −2.59 to −0.31	MD −1.36; 95% CrI −2.48 to −0.23
ConHVE	—	MD 0.40; 95% CrI −2.18 to 2.98	MD −0.80; 95% CrI −3.64 to 2.03	MD 0.20; 95% CrI −2.39 to 2.78	MD 0.29; 95% CrI −2.29 to 2.86
ConPTC	—	—	MD −1.20; 95% CrI −3.20 to 0.79	MD −0.20; 95% CrI −1.82 to 1.42	MD −0.11; 95% CrI −1.72 to 1.50
ConSelectiveHVE	—	—	—	MD 1.00; 95% CrI −0.99 to 2.99	MD 1.09; 95% CrI −0.89 to 3.07
ConSelectivePTC	—	—	—	—	MD 0.09; 95% CrI −1.51 to 1.70
IntPTC	—	—	—	—	—
Blood loss
‐	ConHVE	ConPTC	ConSelectiveHVE	ConSelectivePTC	IntPTC
Control	MD −0.37; 95% CrI −0.94 to 0.22	MD −0.14; 95% CrI −0.52 to 0.14	MD −0.39; 95% CrI −1.16 to 0.27	MD 0.00; 95% CrI −0.57 to 0.45	MD −0.06; 95% CrI −0.39 to 0.17
ConHVE	—	MD 0.23; 95% CrI −0.44 to 0.90	MD −0.02; 95% CrI −0.94 to 0.90	MD 0.37; 95% CrI −0.41 to 1.14	MD 0.31; 95% CrI −0.34 to 0.95
ConPTC	—	—	MD −0.25; 95% CrI −1.04 to 0.54	MD 0.14; 95% CrI −0.47 to 0.74	MD 0.08; 95% CrI −0.35 to 0.52
ConSelectiveHVE	—	—	—	MD 0.39; 95% CrI −0.49 to 1.26	MD 0.33; 95% CrI −0.44 to 1.10
ConSelectivePTC	—	—	—	—	MD −0.06; 95% CrI −0.64 to 0.52
IntPTC	—	—	—	—	—
Con: continuous; Int: intermittent; HVE: hepatic vascular exclusion; PTC: portal triad clamping.
^aThe table provides the effect estimate of each pair‐wise comparison. To identify the effect estimate of a comparison (e.g. A versus B), look at the cell that occupies the column corresponding to treatment A and the row corresponding to treatment B. This gives the information directly. If that cell is empty (indicated by a ' —', you have to look at column corresponding to treatment B and row corresponding to treatment A. You will have to take the inverse of this number (i.e. 1/number) to get the treatment effect. ^bTreatment effects with evidence of difference are shown by italics.

Table 11. Vascular occlusion methods: pair‐wise comparisonsa,b

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Table 12. Intervention and control (ordered by category and comparisons)

Study	Intervention				Co‐interventions
Study	Intervention	Control	Other information	Type of intervention	Vascular occlusion	Parenchymal transection method	Raw surface	Pharmacological methods	Cardiopulmonary methods	Autologous transfusion
Capussotti 2012	Anterior approach	Control	—	Anterior approach	Not stated	Clamp‐crush, bipolar dissecting sealer	Not stated	Not stated	Not stated	Not stated
Liu 2006	Anterior approach	Control	—	Anterior approach	Not stated	Cavitron ultrasonic surgical aspirator	Not stated	Not stated	Not stated	Not stated
Kajikawa 1994	Autologous blood donation	Control	Note: autologous blood donation group was further randomised to recombinant erythropoietin and no erythropoietin	Autologous transfusion	Not stated	Not stated	Not stated	Not stated	Not stated	Factor being randomised
Kostopanagiotou 2007	Autologous blood donation	Control	Autologous blood donation: 2 units of blood were withdrawn before surgery	Autologous transfusion	Hepatic vascular exclusion	Not stated	Not stated	Not stated	Not stated	Factor being randomised
Guo 2013	Acute normovolemic haemodilution plus low central venous pressure	Control	Acute normovolemic dilution plus low central venous pressure: blood withdrawn to a target of 28% haematocrit and replaced with fluid. Target for central venous pressure was not reported	Cardiopulmonary methods	Not stated	Not stated	Not stated	Not stated	Factor being randomised	Not stated
Jarnagin 2008	Acute normovolemic haemodilution plus low central venous pressure	Low central venous pressure	Acute normovolemic haemodilution: blood was withdrawn and replaced by colloids and crystalloids to reach a haematocrit target of 8 gm/dL. Low central venous pressure was maintained < 5 H₂0 using fluid restriction and pharmacologic manipulation	Cardiopulmonary methods	Intermittent portal triad clamping	Not stated	Not stated	Not stated	Factor being randomised	Not stated
Matot 2002	Acute normovolemic haemodilution plus low central venous pressure	Low central venous pressure	Acute normovolemic haemodilution: blood was withdrawn and replaced by colloids to reach a haematocrit target of 24%. Low central venous pressure was achieved by fluid restriction	Cardiopulmonary methods	Not stated	Not stated	Not stated	Not stated	Factor being randomised	Not stated
Yao 2006	Acute normovolemic haemodilution	Acute normovolemic haemodilution with hypotension 3rd group: control	Acute normovolemic haemodilution: withdrawal of blood and replacement with fluids to maintain a target haematocrit of 30%. Acute normovolemic haemodilution with controlled hypotension: in addition to acute normovolemic haemodilution, sodium nitroprusside was used. Target blood pressure not known.	Cardiopulmonary methods	Not stated	Not stated	Not stated	Not stated	Factor being randomised	Not stated
Hasegawa 2002	Hypoventilation	Control	—	Cardiopulmonary methods	Intermittent portal triad clamping or selective occlusion	Clamp crush or cavitron ultrasonic surgical aspirator	Not stated	Not stated	Factor being randomised	None
Choi 2007	Low central venous pressure	Control	Low central venous pressure: by restricting flow from legs	Cardiopulmonary methods	Not stated	Not stated	Not stated	Not stated	Factor being randomised	Not stated
El‐Kharboutly 2004	Low central venous pressure	Control	Low central venous pressure: nitroglycerine	Cardiopulmonary intervention	Intermittent portal triad clamping	Not stated	Not stated	Not stated	Factor being randomised	Not stated
Kato 2008	Low central venous pressure	Control	Low central venous pressure: by inferior IVC clamping	Cardiopulmonary methods	Intermittent portal triad clamping	Cavitron ultrasonic surgical aspirator	Fibrin glue used	Not stated	Factor being randomised	Not stated
Wang 2006	Low central venous pressure	Control	Low central venous pressure: by limiting fluid, nitroglycerine, and furosemide	Cardiopulmonary methods	Varied	Clamp‐crush	Not stated	Not stated	Factor being randomised	Not stated
Guo 2014	Low central venous pressure	Low central venous pressure + acute normovolemic haemodilution. 3rd group: control	Low central venous pressure: fluid restriction and nitroglycerine. Acute normovolemic haemodilution plus low central venous pressure: withdrawal of blood to a target haematocrit of 30% and replacement with colloids	Cardiopulmonary methods	Not stated	Not stated	Not stated	Not stated	Factor being randomised	Not stated
Rahbari 2014	Stapler	Clamp‐crush method	Stapler: Autosuture EndoGIA stapler (Covidien)	Parenchumal transection	Variable	Factor being randomised	Variable	Not stated	Low central venous pressure	Not stated
Koo 2005	Cavitron ultrasonic surgical aspirator	Clamp‐crush method	—	Parenchymal transection	No vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated
Takayama 2001	Cavitron ultrasonic surgical aspirator	Clamp‐crush method	—	Parenchymal transection	Intermittent total or selective portal triad clamping	Factor being randomised	Fibrin glue used	Not stated	Not stated	Not stated
Doklestic 2012	Cavitron ultrasonic surgical aspirator	Clamp‐crush method 3rd group: radiofrequency dissecting sealer	Ultrasonic dissector: cavitron ultrasonic surgical aspirator. Radiofrequency dissecting sealer: Ligasure	Parenchymal transection	Intermittent portal triad clamping	Factor being randomised	Not stated	Not stated	Low central venous pressure	Not stated
Rau 2001	Cavitron ultrasonic surgical aspirator	Hydrojet	Hydrojet: Jet Cutter	Parenchymal transection	Portal triad clamping	Factor being randomised	Variable	Not stated	Not stated	Not stated
Savlid 2013	Cavitron ultrasonic surgical aspirator	Stapler	Stapler: Endostapler (Covidien)	Parenchymal transection	Variable	Factor being randomised	Not stated	Not stated	Not stated	Not stated
Lesurtel 2005	Cavitron ultrasonic surgical aspirator	Radiofrequency dissecting sealer. 3rd group: hydrojet	Radiofrequency dissecting sealer: Tissue Link Hydrojet: Helix Hydro‐Jet A 4th group with clamp‐crush and vascular occlusion was excluded since there was difference in the co‐intervention between the groups	Parenchymal transection	No vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated
Ikeda 2009	Radiofrequency dissecting sealer	Clamp‐crush method	Radiofrequency dissecting sealer: Ligasure	Parenchymal transection	Intermittent portal triad clamping or hemihepatic occlusion	Factor being randomised	Not stated	Not stated	Not stated	No
Lupo 2007	Radiofrequency dissecting sealer	Clamp‐crush method	Radiofrequency dissecting sealer: Radionics needles	Parenchymal transection	No vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated
Muratore 2014	Radiofrequency dissecting sealer	Clamp‐crush method	Radiofrequency dissecting sealer: Ligasure (Covidien)	Parenchymal transection	Not stated	Factor being randomised	No fibrin glue used	Not stated	Low central venous pressure	Not stated
Arita 2005	Radio‐frequency dissecting sealer	Clamp‐crush method	Radio‐frequency dissecting sealer: Tissue Link (Valley Lab)	Parenchymal transection	Variable	Factor being randomised	Not stated	Not stated	Not stated	Not stated
Smyrniotis 2005	Sharp transection	Clamp‐crush method	Sharp transection: using scalpel	Parenchymal transection	Selective hepatic vascular exclusion	Factor being randomised	Not stated	Not stated	Low central venous pressure	Not stated
Shimada 1994	Anti‐thrombin III concentrate	Control	Anti‐thrombin concentrate: 1500 IU IV over 30 min: immediately before the operation, just before hepatic division, and immediately after operation	Pharmacological methods	Not stated	Not stated	Not stated	Factor being randomised	Not stated	Not stated
Lentschener 1997	Aprotinin	Control	Aprotinin: Loading dose: 2 X 10⁶ kIU of aprotinin over a 20 min period after induction of anaesthesia. Continuous infusion: 5 x 10⁵ kIU per hour administered by an infusion pump until skin closure Additional bolus: 5 X 10⁵ KIU of aprotinin was infused every three transfused red b10od cell (red blood cell) packs Control: placebo	Pharmacological methods	Intermittent portal triad clamping	Kelly clamp	Fibrin glue used	Factor being randomised	None	Not stated
Wong 2003	Desmopressin	Control	Desmopressin: 30 mcg/kg shortly after induction Control: placebo	Pharmacological methods	Varied	Cavitron ultrasonic surgical aspirator	Not stated	Factor being randomised	Not stated	Not stated
Lodge 2005	Recombinant factor VIIa	Control	Recombinant factor VIIa: 1st dose: slow intravenous injection (20 mcg/kg or 80 mcg/kg) within 5 min before incision. 2nd dose: identical dose was given 5 h after incision if the surgery time was anticipated to exceed 6 hours Control: placebo	Pharmacological methods	Mixture of methods	Not stated	No fibrin glue used	Factor being randomised	Not stated	No
Shao 2006	Recombinant factor VIIa	Control	Recombinant factor VIIa: brand not stated Dose: 50 or 100 mcg/kg before skin incision over 2 minutes and repeated every 2 hours until a maximum of 4 doses Control: placebo	Pharmacological methods	Not stated	Not stated	Not stated	Factor being randomised	Not stated	Not stated
Wu 2006	Tranexamic acid	Control	Tranexamic acid: 500 mg just before the surgery followed by 250 mg 4x/day for 3 days	Pharmacological methods	Varied	Clamp‐crush method	Not stated	Factor being randomised	Not stated	Not stated
Chapman 2000	Collagen	Fibrin sealant	Collagen: Instat (Johnson & Johnson) Fibrin sealant: Costasis (Cohesion Technologies) ‐ bovine thrombin and collagen combined with patient's own plasma	Raw surface	Not stated	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Franceschi 2006	Collagen	Fibrin sealant	Collagen: Instat (Ethicon) Fibrin sealant: CryoSeal FS	Raw surface	Not stated	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Kohno 1992	Collagen	Fibrin sealant	Collagen: Avitene (Alcon Inc). Fibrin sealant: Beriplast P (Beringwerke AB)	Raw surface	Not stated	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Moench 2014	Collagen	Fibrin sealant	Collagen: Sangustop fleece (Aesculap AG). Fibrin‐based haemostat: Tachosil (Nycomed)	Raw surface	Not stated	A number of parenchymal transection techniques	Factor being randomised	None	Not stated	Not stated
Fischer 2011	Fibrin sealant	Argon beam coagulator	Fibrin sealant: Tacchosil (Nycomed)	Raw surface	A mixture of approaches	A mixture of approaches	Factor being randomised	Not stated	Not stated	Not stated
Frilling 2005	Fibrin sealant	Argon beam coagulator	Fibrin sealant: Tacchosil	Raw surface	Not stated	A mixture of approaches	Factor being randomised	Not stated	Not stated	Not stated
Bektas 2014	Fibrin sealant	Control	Fibrin sealant: TISSEEL (Baxter Health Corporation) Spray; 5 mL of fibrinogen with synthetic aprotinin and 5 mL of thrombin (500 IU/mL)	Raw surface	Intermittent portal triad clamping	Different types of liver resection	Factor being randomised	Not stated	Not stated	Not stated
De Boer 2012	Fibrin sealant	Control	Fibrin sealant: Quixil (Johnson & Johnson Medical) spray; 5 mL of fibrinogen and tranexamic acid and 5 mL of thrombin	Raw surface	With and without inflow occlusion	Clamp‐crush, cavitron ultrasonic surgical aspirator, electric coagulation based, combined	Factor being randomised	Not stated	Not stated	Not stated
Liu 1993	Fibrin sealant	Control	Fibrin sealant: name not available	Raw surface	Not stated	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Noun 1996	Fibrin sealant	Control	Fibrin sealant: Biocol	Raw surface	Varied	Clamp‐crush method or cavitron ultrasonic surgical aspirator	Factor being randomised	Not stated	Not stated	Not stated
Porte 2012	Fibrin sealant	Gelatin	Fibrin sealant: Fibrocaps (ProFibrix)	Raw surface	Not stated	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Genyk 2014	Fibrin sealant	Oxidised cellulose	Fibrin sealant: Tacchosil Oxidised cellulose: Surgicel	Raw surface	Not stated	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Koea 2013	Fibrin sealant	Oxidised cellulose	Fibrin sealant: Fibrin Pad Oxidised cellulose: no further details	Raw surface	Not stated	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Ollinger 2013	Fibrin sealant	Oxidised cellulose	Fibrin sealant: Tachosil (Nycomed) Oxidised cellulose: Veriset (Covidien)	Raw surface	Varied	Not stated	Factor being randomised	Not stated	Not stated	Not stated
Kakaei 2013	Fibrin sealant	Oxidised cellulose 3rd group: cyanoacrylate	Oxidised cellulose: Surgicel (Ethicon Inc) Cyanoacrylate: Glubran 2 (GEM SRL) Fibrin sealant: Tachosil (Takeda Pharmaceuticals)	Raw surface	Not stated	Clamp‐crush method	Factor being randomised	Not stated	Not stated	Not stated
Gugenheim 2011	Fibrin sealant	PlasmaJet coagulator	Fibrin sealant: fibrin glue (no further details)	Raw surface	Not stated	Cavitron ultrasonic surgical aspirator	Factor being randomised	Not stated	Not stated	Not stated
Figueras 2007	Fibrin sealant plus collagen	Control	Fibrin sealant spray: Tissucol Collagen: collagen sponge (Johnson & Johnson) Note: In both groups, bleeding from raw surface was controlled using argon beam coagulator or Tissuelink	Raw surface	Intermittent portal triad or selective clamping	Cavitron ultrasonic surgical aspirator	Factor being randomised	Not stated	Not stated	Not stated
Belghiti 1996	Continuous portal triad clamping	Continuous hepatic vascular exclusion	Hepatic vascular exclusion by encircling the entire retrohepatic inferior vena cava	Vascular occlusion	Factor being randomised	Clamp‐crush or cavitron ultrasonic surgical aspirator	Fibrin glue used	Not stated	Not stated	Not stated
Chen 2006	Continuous portal triad clamping	Continuous hepatic vascular exclusion	Hepatic vascular exclusion by encircling the entire infrahepatic inferior vena cava	Vascular occlusion	Factor being randomised	Clamp‐crush method	Not stated	Not stated	Not stated	Not stated
Si‐Yuan 2014	Continuous portal triad clamping	Continuous selective hepatic vascular exclusion	—	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Low central venous pressure	Not stated
Ni 2013	Continuous portal triad clamping	Continuous selective portal triad clamping	—	Vascular occlusion	Factor being randomised	Clamp‐crush method	Not stated	Not stated	Low central venous pressure	Not stated
Chouker 2004	Continuous portal triad clamping	Control	—	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated	Not stated
Clavien 1996	Continuous portal triad clamping	Control	Note: After every 1 hour of continuous portal triad clamping (or 30 minutes for cirrhotic patients), the clamp was released for 10 minutes before reclamping	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated	Not stated
Dayangac 2010	Continuous portal triad clamping	Control	—	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated	Not stated
Pietsch 2010	Continuous portal triad clamping	Control	—	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated	Not stated
Belghiti 1999	Continuous portal triad clamping	Intermittent portal triad clamping	Continuous portal triad clamping: until end of transection Intermittent portal triad clamping: 15 minutes on and 5 minutes off until hepatectomy	Vascular occlusion	Factor being randomised	Cavitron ultrasonic surgical aspirator	Not stated	Not stated	Low central venous pressure	Not stated
Capussotti 2003	Continuous portal triad clamping	Intermittent portal triad clamping	Intermittent portal triad clamping: 15 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Clamp‐crush	Fibrin glue used	Not stated	Not stated	Not stated
Liang 2009	Continuous selective portal triad clamping	Intermittent portal triad clamping	Intermittent portal triad clamping: 20 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Clamp crush	Not stated	None	Not stated	Not stated
Capussotti 2006	Intermittent portal triad clamping	Control	Intermittent portal triad clamping: 15 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Clamp‐crush or bipolar dissecting sealer	Not stated	Not stated	Low central venous pressure	Not stated
Lee 2012	Intermittent portal triad clamping	Control	Intermittent portal triad clamping: 15 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Cavitron ultrasonic surgical aspirator	Fibrin glue used	Not stated	Low central venous pressure	Not stated
Man 1997	Intermittent portal triad clamping	Control	Intermittent portal triad clamping: 20 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Cavitron ultrasonic surgical aspirator	Not stated	Not stated	Not stated	Not stated
Man 2003	Intermittent portal triad clamping	Control	Intermittent portal triad clamping: 20 minutes on and 5 minutes off (until resection is completed or a maximum of 6 cycles)	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated	Not stated
Park 2012	Intermittent portal triad clamping	Control	Intermittent portal triad clamping: 15 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated	Not stated
Figueras 2005	Intermittent portal triad clamping	Intermittent selective portal triad clamping	Intermittent clamping: 15 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Not stated	Not stated	Not stated	Not stated	Not stated
Wu 2002	Intermittent portal triad clamping	Intermittent selective portal triad clamping	Intermittent portal triad clamping: 15 minutes on and 5 minutes off Intermittent selective portal triad clamping: 30 minutes on and 5 minutes off	Vascular occlusion	Factor being randomised	Clamp‐crush method	Not stated	Not stated	Not stated	Not stated

Table 12. Intervention and control (ordered by category and comparisons)

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Table 13. Risk of bias (ordered by category and comparisons)

Study	Intervention	Control	Sequence generation	Allocation concealment	Blinding of participants and healthcare providers	Blinding of outcome assessors	Missing outcome bias	Selective reporting bias	Source of funding bias	Other bias	Overall risk of bias
Capussotti 2012	Anterior approach	Control	Low	Unclear	Unclear	Unclear	High	Low	Low	Low	Unclear or high
Liu 2006	Anterior approach	Control	Unclear	Unclear	High	High	High	High	Low	Low	Unclear or high
Kajikawa 1994	Autologous blood donation	Control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Kostopanagiotou 2007	Autologous blood donation	Control	Unclear	Unclear	Unclear	Unclear	High	High	Unclear	Low	Unclear or high
Guo 2013	Acute normovolemic haemodilution plus low central venous pressure	Control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Low	Low	Unclear or high
Jarnagin 2008	Acute normovolemic haemodilution plus low central venous pressure	Low central venous pressure	Unclear	Unclear	Unclear	Unclear	High	Low	Unclear	Low	Unclear or high
Matot 2002	Acute normovolemic haemodilution plus low central venous pressure	Low central venous pressure	Low	Unclear	High	Unclear	Low	High	Low	Low	Unclear or high
Yao 2006	Acute normovolemic haemodilution	Acute normovolemic haemodilution with hypotension 3rd group: control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Hasegawa 2002	Hypoventilation	Control	Low	Low	Low	High	Low	High	Low	Low	Unclear or high
Choi 2007	Low central venous pressure	Control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
El‐Kharboutly 2004	Low central venous pressure	Control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Kato 2008	Low central venous pressure	Control	Low	Low	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Wang 2006	Low central venous pressure	Control	Unclear	Unclear	Unclear	Unclear	High	High	Unclear	Low	Unclear or high
Guo 2014	Low central venous pressure	Low central venous pressure + acute normovolemic haemodilution. 3rd group: control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Low	Low	Unclear or high
Rahbari 2014	Stapler	Clamp‐crush method	Low	Low	High	Low	Low	Low	High	Low	Unclear or high
Koo 2005	Cavitron ultrasonic surgical aspirator	Clamp‐crush method	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Takayama 2001	Cavitron ultrasonic surgical aspirator	Clamp‐crush method	Unclear	Unclear	Unclear	Unclear	Low	Low	Unclear	Low	Unclear or high
Doklestic 2012	Cavitron ultrasonic surgical aspirator	Clamp‐crush method. 3rd group: radiofrequency dissecting sealer	Unclear	Unclear	Unclear	Unclear	Unclear	Low	Low	Low	Unclear or high
Rau 2001	Cavitron ultrasonic surgical aspirator	Hydrojet	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Savlid 2013	Cavitron ultrasonic surgical aspirator	Stapler	Low	Low	Unclear	Unclear	Low	Low	High	Low	Unclear or high
Lesurtel 2005	Cavitron ultrasonic surgical aspirator	Radiofrequency dissecting sealer. 3rd group: hydrojet	Unclear	Unclear	Unclear	Unclear	Low	Low	High	Low	Unclear or high
Ikeda 2009	Radiofrequency dissecting sealer	Clamp‐crush method	Low	Unclear	High	High	Low	Low	Low	Low	Unclear or high
Lupo 2007	Radiofrequency dissecting sealer	Clamp‐crush method	Low	Unclear	Unclear	Unclear	Low	High	Low	Low	Unclear or high
Muratore 2014	Radiofrequency dissecting sealer	Clamp‐crush method	Low	Low	Unclear	High	Low	Low	Low	Low	Unclear or high
Arita 2005	Radio‐frequency dissecting sealer	Clamp‐crush method	Low	Low	High	High	Low	Low	Low	Low	Unclear or high
Smyrniotis 2005	Sharp transection	Clamp‐crush method	Unclear	Unclear	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Shimada 1994	Anti‐thrombin III concentrate	Control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Lentschener 1997	Aprotinin	Control	Low	Unclear	Unclear	Low	High	High	High	Low	Unclear or high
Wong 2003	Desmopressin	Control	Unclear	Unclear	Low	Low	High	High	Low	Low	Unclear or high
Lodge 2005	Recombinant factor VIIa	Control	Low	Low	Low	Low	High	Low	High	Low	Unclear or high
Shao 2006	Recombinant factor VIIa	Control	Unclear	Unclear	Unclear	Unclear	High	High	High	Low	Unclear or high
Wu 2006	Tranexamic acid	Control	Unclear	Unclear	Low	Low	Low	High	Unclear	Low	Unclear or high
Chapman 2000	Collagen	Fibrin sealant	Low	Unclear	Unclear	Unclear	High	High	High	Low	Unclear or high
Franceschi 2006	Collagen	Fibrin sealant	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Kohno 1992	Collagen	Fibrin sealant	Unclear	Unclear	Unclear	Unclear	Low	Low	Unclear	Low	Unclear or high
Moench 2014	Collagen	Fibrin sealant	Low	Low	High	High	High	Low	High	Low	Unclear or high
Fischer 2011	Fibrin sealant	Argon beam coagulator	Unclear	Low	High	High	High	Low	High	Low	Unclear or high
Frilling 2005	Fibrin sealant	Argon beam coagulator	Unclear	Unclear	High	High	Low	Low	Unclear	Low	Unclear or high
Bektas 2014	Fibrin sealant	Control	Low	Low	High	High	Low	Low	High	Low	Unclear or high
De Boer 2012	Fibrin sealant	Control	Low	Low	High	High	Low	Low	High	Low	Unclear or high
Liu 1993	Fibrin sealant	Control	Unclear	Unclear	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Noun 1996	Fibrin sealant	Control	Unclear	Unclear	Unclear	Unclear	High	High	Unclear	Low	Unclear or high
Porte 2012	Fibrin sealant	Gelatin	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Genyk 2014	Fibrin sealant	Oxidised cellulose	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Koea 2013	Fibrin sealant	Oxidised cellulose	Low	Low	High	High	High	High	High	Low	Unclear or high
Ollinger 2013	Fibrin sealant	Oxidised cellulose	Unclear	Unclear	High	High	Low	Low	High	Low	Unclear or high
Kakaei 2013	Fibrin sealant	Oxidised cellulose 3rd group: cyanoacrylate	Low	Unclear	High	Unclear	Unclear	High	Low	Low	Unclear or high
Gugenheim 2011	Fibrin sealant	PlasmaJet coagulator	Unclear	Unclear	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Figueras 2007	Fibrin sealant plus collagen	Control	Low	Low	Unclear	Unclear	Low	Low	Low	Low	Unclear or high
Belghiti 1996	Continuous portal triad clamping	Continuous hepatic vascular exclusion	Unclear	Unclear	Unclear	Unclear	High	High	Unclear	Low	Unclear or high
Chen 2006	Continuous portal triad clamping	Continuous hepatic vascular exclusion	Unclear	Unclear	Unclear	Unclear	Unclear	Low	Low	Low	Unclear or high
Si‐Yuan 2014	Continuous portal triad clamping	Continuous selective hepatic vascular exclusion	Unclear	Low	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Ni 2013	Continuous portal triad clamping	Continuous selective portal triad clamping	Unclear	Low	Unclear	Unclear	Low	Low	Low	Low	Unclear or high
Chouker 2004	Continuous portal triad clamping	Control	Unclear	Unclear	High	Unclear	High	High	Unclear	Low	Unclear or high
Clavien 1996	Continuous portal triad clamping	Control	Unclear	Unclear	Unclear	Unclear	High	High	Low	Low	Unclear or high
Dayangac 2010	Continuous portal triad clamping	Control	Low	Low	High	Low	Low	High	Low	Low	Unclear or high
Pietsch 2010	Continuous portal triad clamping	Control	Unclear	Unclear	Unclear	Unclear	Unclear	High	Unclear	Low	Unclear or high
Belghiti 1999	Continuous portal triad clamping	Intermittent portal triad clamping	Unclear	Unclear	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Capussotti 2003	Continuous portal triad clamping	Intermittent portal triad clamping	Low	Unclear	Unclear	Unclear	Low	Low	Unclear	Low	Unclear or high
Liang 2009	Continuous selective portal triad clamping	Intermittent portal triad clamping	Unclear	Unclear	Unclear	Unclear	Low	Low	Low	Low	Unclear or high
Capussotti 2006	Intermittent portal triad clamping	Control	Low	Unclear	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Lee 2012	Intermittent portal triad clamping	Control	Low	Low	High	High	Low	Low	Low	Low	Unclear or high
Man 1997	Intermittent portal triad clamping	Control	Unclear	Unclear	Unclear	Unclear	Low	High	Low	Low	Unclear or high
Man 2003	Intermittent portal triad clamping	Control	Unclear	Unclear	Unclear	Unclear	Low	High	Unclear	Low	Unclear or high
Park 2012	Intermittent portal triad clamping	Control	Low	Low	Unclear	Unclear	High	High	Low	Low	Unclear or high
Figueras 2005	Intermittent portal triad clamping	Intermittent selective portal triad clamping	Unclear	Unclear	Unclear	Unclear	Low	High	Low	Low	Unclear or high
Wu 2002	Intermittent portal triad clamping	Intermittent selective portal triad clamping	Unclear	Unclear	Unclear	Unclear	Low	Low	Low	Low	Unclear or high

Table 13. Risk of bias (ordered by category and comparisons)

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Comparison 1. Anterior approach vs conventional approach

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (perioperative) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Anterior approach vs conventional approach	2	185	Odds Ratio (M‐H, Fixed, 95% CI)	0.27 [0.05, 1.32]
2 Serious adverse events (proportion) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 Anterior approach vs conventional approach	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Adverse events (proportion) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 Anterior approach vs conventional approach	2	185	Odds Ratio (M‐H, Fixed, 95% CI)	0.89 [0.48, 1.64]
4 Adverse events (number) Show forest plot	1		Rate Ratio (Fixed, 95% CI)	Totals not selected

4.1 Anterior approach vs conventional approach	1		Rate Ratio (Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Blood transfusion (proportion) Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Anterior approach vs conventional approach	2	185	Odds Ratio (M‐H, Random, 95% CI)	0.60 [0.05, 6.74]
6 Major blood loss (proportion) Show forest plot	2		Odds Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Anterior approach vs conventional approach	2	185	Odds Ratio (M‐H, Random, 95% CI)	0.56 [0.09, 3.41]

Comparison 1. Anterior approach vs conventional approach

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Comparison 2. Autologous blood donation vs control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Adverse events (proportion) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Autologous blood donation vs control	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Blood transfusion (proportion) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 Autologous blood donation vs control	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Blood transfusion (red blood cell) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

3.1 Autologous blood donation vs control	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Blood loss Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Autologous blood donation vs control	2	70	Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.37, 0.34]
5 Major blood loss (proportion) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5.1 Autologous blood donation vs control	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Total hospital stay Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

6.1 Autologous blood donation vs control	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Operating time Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.1 Autologous blood donation vs control	2	70	Mean Difference (IV, Fixed, 95% CI)	‐3.79 [‐34.28, 26.70]

Comparison 2. Autologous blood donation vs control

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Comparison 3. Cardiopulmonary interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (perioperative) Show forest plot	4		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Hypoventilation vs control	1	79	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Low central venous pressure vs control	1	85	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	2	208	Odds Ratio (M‐H, Fixed, 95% CI)	2.91 [0.29, 28.70]
2 Serious adverse events (proportion) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 Hypoventilation vs control	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Serious adverse events (number) Show forest plot	2		Rate Ratio (Fixed, 95% CI)	Totals not selected

3.1 Low central venous pressure vs control	1		Rate Ratio (Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	1		Rate Ratio (Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Adverse events (proportion) Show forest plot	4		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 Hypoventilation vs control	1	79	Odds Ratio (M‐H, Fixed, 95% CI)	1.33 [0.53, 3.34]
4.2 Low central venous pressure vs control	1	50	Odds Ratio (M‐H, Fixed, 95% CI)	0.79 [0.21, 3.03]
4.3 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	2	208	Odds Ratio (M‐H, Fixed, 95% CI)	0.68 [0.37, 1.23]
5 Adverse events (number) Show forest plot	2		Rate Ratio (Fixed, 95% CI)	Totals not selected

5.1 Low central venous pressure vs control	1		Rate Ratio (Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	1		Rate Ratio (Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Blood transfusion (proportion) Show forest plot	6		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Hypoventilation vs control	1	79	Odds Ratio (M‐H, Fixed, 95% CI)	0.71 [0.15, 3.40]
6.2 Low central venous pressure vs control	3	175	Odds Ratio (M‐H, Fixed, 95% CI)	0.49 [0.21, 1.13]
6.3 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	2	208	Odds Ratio (M‐H, Fixed, 95% CI)	3.09 [1.49, 6.42]
7 Blood transfusion (red blood cell) Show forest plot	6		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.1 Acute normovolemic haemodilution vs control	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.25 [‐1.74, ‐0.75]
7.2 Acute normovolemic haemodilution plus hypotension vs control	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.66 [‐2.05, ‐1.28]
7.3 Acute normovolemic haemodilution plus low central venous pressure vs control	1	30	Mean Difference (IV, Fixed, 95% CI)	0.27 [0.02, 0.51]
7.4 Low central venous pressure vs control	2	90	Mean Difference (IV, Fixed, 95% CI)	‐1.60 [‐2.26, ‐0.93]
7.5 Acute normovolemic haemodilution plus hypotension vs acute normovolemic haemodilution	1	20	Mean Difference (IV, Fixed, 95% CI)	‐0.42 [‐0.74, ‐0.10]
7.6 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	2	208	Mean Difference (IV, Fixed, 95% CI)	0.16 [‐0.63, 0.95]
8 Blood transfusion (fresh frozen plasma) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

8.1 Low central venous pressure vs control	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Blood transfusion (cryoprecipitate) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

9.1 Hypoventilation vs control	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Blood loss Show forest plot	9		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

10.1 Acute normovolemic haemodilution vs control	1	20	Mean Difference (IV, Fixed, 95% CI)	0.00 [‐0.10, 0.11]
10.2 Acute normovolemic haemodilution plus hypotension vs control	1	20	Mean Difference (IV, Fixed, 95% CI)	‐0.25 [‐0.36, ‐0.14]
10.3 Acute normovolemic haemodilution plus low central venous pressure vs control	1	30	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.03, 0.08]
10.4 Hypoventilation vs control	1	79	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐1.12, 1.12]
10.5 Low central venous pressure vs control	4	237	Mean Difference (IV, Fixed, 95% CI)	‐0.34 [‐0.47, ‐0.22]
10.6 Acute normovolemic haemodilution plus hypotension vs acute normovolemic haemodilution	1	20	Mean Difference (IV, Fixed, 95% CI)	‐0.25 [‐0.39, ‐0.11]
10.7 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	2	208	Mean Difference (IV, Fixed, 95% CI)	‐0.09 [‐0.32, 0.15]
11 Major blood loss (proportion) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

11.1 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Hospital stay Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.1 Hypoventilation vs control	1	79	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐3.79, 3.79]
12.2 Low central venous pressure vs control	3	197	Mean Difference (IV, Fixed, 95% CI)	‐2.43 [‐3.93, ‐0.94]
12.3 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	1	130	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐2.96, 2.96]
13 Operating time Show forest plot	7		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

13.1 Acute normovolemic haemodilution plus low central venous pressure vs control	1	40	Mean Difference (IV, Fixed, 95% CI)	‐17.0 [‐42.78, 8.78]
13.2 Hypoventilation vs control	1	79	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐88.21, 88.21]
13.3 Low central venous pressure vs control	4	192	Mean Difference (IV, Fixed, 95% CI)	‐17.41 [‐31.14, ‐3.67]
13.4 Low central venous pressure vs acute normovolemic haemodilution plus low central venous pressure	3	248	Mean Difference (IV, Fixed, 95% CI)	13.63 [‐4.11, 31.38]

Comparison 3. Cardiopulmonary interventions

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Comparison 4. Methods of parenchymal transection

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (perioperative) Show forest plot	11		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	2	172	Odds Ratio (M‐H, Fixed, 95% CI)	0.18 [0.01, 4.01]
1.2 Radiofrequency dissecting sealer vs clamp‐crush method	5	390	Odds Ratio (M‐H, Fixed, 95% CI)	1.85 [0.38, 8.97]
1.3 Sharp transection method vs clamp‐crush method	1	82	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Stapler vs clamp‐crush method	1	130	Odds Ratio (M‐H, Fixed, 95% CI)	2.07 [0.36, 11.69]
1.5 Hydrojet vs cavitron ultrasonic surgical aspirator	2	111	Odds Ratio (M‐H, Fixed, 95% CI)	0.99 [0.19, 5.17]
1.6 Radiofrequency dissecting sealer vs cavitron ultrasonic surgical aspirator	2	90	Odds Ratio (M‐H, Fixed, 95% CI)	0.66 [0.11, 4.05]
1.7 Stapler vs cavitron ultrasonic surgical aspirator	1	100	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.8 Radiofrequency dissecting sealer vs hydrojet	1	50	Odds Ratio (M‐H, Fixed, 95% CI)	0.18 [0.01, 4.04]
2 Serious adverse events (proportion) Show forest plot	7		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	2	172	Odds Ratio (M‐H, Fixed, 95% CI)	0.35 [0.09, 1.35]
2.2 Radiofrequency dissecting sealer vs clamp‐crush method	3	240	Odds Ratio (M‐H, Fixed, 95% CI)	0.85 [0.27, 2.63]
2.3 Sharp transection method vs clamp‐crush method	1	82	Odds Ratio (M‐H, Fixed, 95% CI)	2.11 [0.36, 12.20]
2.4 Stapler vs clamp‐crush method	1	130	Odds Ratio (M‐H, Fixed, 95% CI)	1.26 [0.58, 2.75]
2.5 Hydrojet vs cavitron ultrasonic surgical aspirator	1	61	Odds Ratio (M‐H, Fixed, 95% CI)	0.62 [0.10, 4.00]
2.6 Radiofrequency dissecting sealer vs cavitron ultrasonic surgical aspirator	1	40	Odds Ratio (M‐H, Fixed, 95% CI)	1.0 [0.06, 17.18]
3 Serious adverse events (number) Show forest plot	5		Rate Ratio (Fixed, 95% CI)	Subtotals only

3.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	1	132	Rate Ratio (Fixed, 95% CI)	0.67 [0.11, 3.99]
3.2 Radiofrequency dissecting sealer vs clamp‐crush method	2	130	Rate Ratio (Fixed, 95% CI)	3.34 [1.08, 10.31]
3.3 Hydrojet vs cavitron ultrasonic surgical aspirator	1	50	Rate Ratio (Fixed, 95% CI)	1.50 [0.25, 8.98]
3.4 Radiofrequency dissecting sealer vs cavitron ultrasonic surgical aspirator	1	50	Rate Ratio (Fixed, 95% CI)	1.50 [0.25, 8.98]
3.5 Stapler vs cavitron ultrasonic surgical aspirator	1	100	Rate Ratio (Fixed, 95% CI)	1.33 [0.56, 3.16]
3.6 Radiofrequency dissecting sealer vs hydrojet	1	50	Rate Ratio (Fixed, 95% CI)	1.0 [0.20, 4.95]
4 Adverse events (proportion) Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	3	222	Odds Ratio (M‐H, Fixed, 95% CI)	1.30 [0.73, 2.34]
4.2 Radiofrequency dissecting sealer vs clamp‐crush method	3	220	Odds Ratio (M‐H, Fixed, 95% CI)	0.92 [0.51, 1.64]
4.3 Sharp transection method vs clamp‐crush method	1	82	Odds Ratio (M‐H, Fixed, 95% CI)	1.11 [0.46, 2.68]
4.4 Stapler vs clamp‐crush method	1	130	Odds Ratio (M‐H, Fixed, 95% CI)	1.06 [0.53, 2.12]
4.5 Hydrojet vs cavitron ultrasonic surgical aspirator	1	61	Odds Ratio (M‐H, Fixed, 95% CI)	0.29 [0.07, 1.24]
4.6 Radiofrequency dissecting sealer vs cavitron ultrasonic surgical aspirator	1	40	Odds Ratio (M‐H, Fixed, 95% CI)	1.86 [0.52, 6.61]
5 Adverse events (number) Show forest plot	7		Rate Ratio (Fixed, 95% CI)	Subtotals only

5.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	1	132	Rate Ratio (Fixed, 95% CI)	1.56 [0.83, 2.93]
5.2 Radiofrequency dissecting sealer vs clamp‐crush method	3	250	Rate Ratio (Fixed, 95% CI)	1.67 [0.95, 2.94]
5.3 Sharp transection method vs clamp‐crush method	1	82	Rate Ratio (Fixed, 95% CI)	1.12 [0.57, 2.21]
5.4 Hydrojet vs cavitron ultrasonic surgical aspirator	1	50	Rate Ratio (Fixed, 95% CI)	0.88 [0.32, 2.41]
5.5 Radiofrequency dissecting sealer vs cavitron ultrasonic surgical aspirator	1	50	Rate Ratio (Fixed, 95% CI)	1.12 [0.43, 2.92]
5.6 Stapler vs cavitron ultrasonic surgical aspirator	1	100	Rate Ratio (Fixed, 95% CI)	1.16 [0.63, 2.14]
5.7 Radiofrequency dissecting sealer vs hydrojet	1	50	Rate Ratio (Fixed, 95% CI)	1.29 [0.48, 3.45]
6 Blood transfusion (proportion) Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	2	172	Odds Ratio (M‐H, Fixed, 95% CI)	1.37 [0.29, 6.59]
6.2 Radiofrequency dissecting sealer vs clamp‐crush method	5	390	Odds Ratio (M‐H, Fixed, 95% CI)	1.13 [0.63, 2.03]
6.3 Sharp transection method vs clamp‐crush method	1	82	Odds Ratio (M‐H, Fixed, 95% CI)	0.80 [0.32, 2.01]
6.4 Hydrojet vs cavitron ultrasonic surgical aspirator	1	50	Odds Ratio (M‐H, Fixed, 95% CI)	1.0 [0.30, 3.28]
6.5 Radiofrequency dissecting sealer vs cavitron ultrasonic surgical aspirator	2	90	Odds Ratio (M‐H, Fixed, 95% CI)	0.77 [0.29, 2.09]
6.6 Radiofrequency dissecting sealer vs hydrojet	1	50	Odds Ratio (M‐H, Fixed, 95% CI)	0.53 [0.15, 1.93]
7 Blood transfusion (red blood cell) Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

7.1 Sharp transection method vs clamp‐crush method	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 Stapler vs clamp‐crush method	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.3 Hydrojet vs cavitron ultrasonic surgical aspirator	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.4 Stapler vs cavitron ultrasonic surgical aspirator	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Blood transfusion (fresh frozen plasma) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

8.1 Stapler vs clamp‐crush method	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Blood loss Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

9.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 Hydrojet vs cavitron ultrasonic surgical aspirator	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Operating time Show forest plot	6		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

10.1 Cavitron ultrasonic surgical aspirator vs clamp‐crush method	2	90	Mean Difference (IV, Fixed, 95% CI)	27.47 [‐2.87, 57.81]
10.2 Radiofrequency dissecting sealer vs clamp‐crush method	2	90	Mean Difference (IV, Fixed, 95% CI)	16.11 [‐11.45, 43.67]
10.3 Sharp transection method vs clamp‐crush method	1	82	Mean Difference (IV, Fixed, 95% CI)	‐6.0 [‐90.85, 78.85]
10.4 Stapler vs clamp‐crush method	1	130	Mean Difference (IV, Fixed, 95% CI)	‐31.0 [‐60.40, ‐1.60]
10.5 Radiofrequency dissecting sealer vs cavitron ultrasonic surgical aspirator	1	40	Mean Difference (IV, Fixed, 95% CI)	25.0 [‐96.48, 146.48]
10.6 Stapler vs cavitron ultrasonic surgical aspirator	1	100	Mean Difference (IV, Fixed, 95% CI)	‐26.0 [‐87.12, 35.12]

Comparison 4. Methods of parenchymal transection

Ir a la tabla de la revisión

Comparison 5. Methods of dealing with cut surface

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (perioperative) Show forest plot	10		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Fibrin sealant vs control	2	380	Odds Ratio (M‐H, Fixed, 95% CI)	3.56 [0.73, 17.35]
1.2 Fibrin sealant and collagen vs control	1	300	Odds Ratio (M‐H, Fixed, 95% CI)	3.08 [0.61, 15.53]
1.3 Fibrin sealant vs argon beam	2	227	Odds Ratio (M‐H, Fixed, 95% CI)	1.37 [0.46, 4.03]
1.4 Fibrin sealant vs collagen	3	256	Odds Ratio (M‐H, Fixed, 95% CI)	0.90 [0.24, 3.32]
1.5 Oxidised cellulose vs fibrin sealant	1	50	Odds Ratio (M‐H, Fixed, 95% CI)	0.55 [0.03, 9.33]
1.6 Plasmajet vs fibrin sealant	1	58	Odds Ratio (M‐H, Fixed, 95% CI)	0.64 [0.10, 4.16]
2 Serious adverse events (proportion) Show forest plot	7		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Fibrin sealant vs control	3	457	Odds Ratio (M‐H, Fixed, 95% CI)	1.03 [0.64, 1.65]
2.2 Fibrin sealant vs argon beam	1	106	Odds Ratio (M‐H, Fixed, 95% CI)	0.62 [0.25, 1.55]
2.3 Fibrin sealant vs collagen	1	127	Odds Ratio (M‐H, Fixed, 95% CI)	1.57 [0.73, 3.38]
2.4 Oxidised cellulose vs fibrin sealant	1	50	Odds Ratio (M‐H, Fixed, 95% CI)	0.57 [0.17, 1.87]
2.5 Plasmajet vs fibrin sealant	1	58	Odds Ratio (M‐H, Fixed, 95% CI)	0.14 [0.02, 1.22]
3 Serious adverse events (number) Show forest plot	6		Rate Ratio (Fixed, 95% CI)	Subtotals only

3.1 Fibrin sealant vs control	1	70	Rate Ratio (Fixed, 95% CI)	0.94 [0.48, 1.86]
3.2 Fibrin sealant and collagen vs control	1	300	Rate Ratio (Fixed, 95% CI)	1.32 [0.76, 2.29]
3.3 Fibrin sealant vs argon beam	1	121	Rate Ratio (Fixed, 95% CI)	4.47 [1.50, 13.27]
3.4 Fibrin sealant vs collagen	2	189	Rate Ratio (Fixed, 95% CI)	1.22 [0.76, 1.98]
3.5 Fibrin sealant vs cyanoacrylate	1	30	Rate Ratio (Fixed, 95% CI)	1.0 [0.06, 15.99]
3.6 Oxidised cellulose vs cyanoacrylate	1	30	Rate Ratio (Fixed, 95% CI)	4.00 [0.45, 35.79]
3.7 Oxidised cellulose vs fibrin sealant	1	30	Rate Ratio (Fixed, 95% CI)	4.00 [0.45, 35.79]
4 Adverse events (proportion) Show forest plot	9		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 Fibrin sealant versus control	3	457	Odds Ratio (M‐H, Fixed, 95% CI)	0.80 [0.55, 1.17]
4.2 Fibrin sealant and collagen vs control	1	300	Odds Ratio (M‐H, Fixed, 95% CI)	1.0 [0.59, 1.71]
4.3 Fibrin sealant vs argon beam	2	227	Odds Ratio (M‐H, Fixed, 95% CI)	0.97 [0.58, 1.64]
4.4 Fibrin sealant vs collagen	1	127	Odds Ratio (M‐H, Fixed, 95% CI)	0.95 [0.46, 1.93]
4.5 Oxidised cellulose vs fibrin sealant	2	274	Odds Ratio (M‐H, Fixed, 95% CI)	0.77 [0.30, 2.01]
5 Adverse events (number) Show forest plot	5		Rate Ratio (Fixed, 95% CI)	Subtotals only

5.1 Fibrin sealant vs control	1	70	Rate Ratio (Fixed, 95% CI)	1.01 [0.75, 1.36]
5.2 Fibrin sealant vs argon beam	1	121	Rate Ratio (Fixed, 95% CI)	1.12 [0.75, 1.66]
5.3 Fibrin sealant vs collagen	2	189	Rate Ratio (Fixed, 95% CI)	1.13 [0.90, 1.42]
5.4 Fibrin sealant vs cyanoacrylate	1	30	Rate Ratio (Fixed, 95% CI)	1.50 [0.25, 8.98]
5.5 Oxidised cellulose vs cyanoacrylate	1	30	Rate Ratio (Fixed, 95% CI)	3.50 [0.73, 16.85]
5.6 Oxidised cellulose vs fibrin sealant	1	30	Rate Ratio (Fixed, 95% CI)	2.33 [0.60, 9.02]
6 Blood transfusion (proportion) Show forest plot	4		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Fibrin sealant vs control	2	392	Odds Ratio (M‐H, Fixed, 95% CI)	1.04 [0.61, 1.76]
6.2 Fibrin sealant and collagen vs control	1	300	Odds Ratio (M‐H, Fixed, 95% CI)	1.52 [0.88, 2.61]
6.3 Fibrin sealant vs cyanoacrylate	1	30	Odds Ratio (M‐H, Fixed, 95% CI)	3.25 [0.52, 20.37]
6.4 Oxidised cellulose vs cyanoacrylate	1	30	Odds Ratio (M‐H, Fixed, 95% CI)	2.36 [0.36, 15.45]
6.5 Oxidised cellulose vs fibrin sealant	1	30	Odds Ratio (M‐H, Fixed, 95% CI)	0.73 [0.15, 3.49]
7 Blood transfusion (red blood cell) Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

7.1 Fibrin sealant vs control	2	122	Mean Difference (IV, Random, 95% CI)	‐0.53 [‐1.00, ‐0.06]
7.2 Fibrin sealant and collagen vs control	1	300	Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.16, 0.14]
7.3 Fibrin sealant vs collagen	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
7.4 Fibrin sealant vs cyanoacrylate	1	30	Mean Difference (IV, Random, 95% CI)	2.2 [1.59, 2.81]
7.5 Oxidised cellulose vs cyanoacrylate	1	30	Mean Difference (IV, Random, 95% CI)	‐0.27 [‐0.81, 0.27]
7.6 Oxidised cellulose vs fibrin sealant	2	80	Mean Difference (IV, Random, 95% CI)	‐1.76 [‐2.00, 0.47]
8 Blood transfusion (fresh frozen plasma) Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

8.1 Fibrin sealant vs cyanoacrylate	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.8 [‐1.01, ‐0.59]
8.2 Oxidised cellulose vs cyanoacrylate	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.27 [‐0.55, 0.01]
8.3 Oxidised cellulose vs fibrin sealant	2	80	Mean Difference (IV, Fixed, 95% CI)	0.53 [0.35, 0.71]
9 Blood loss Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.1 Fibrin sealant vs control	2	350	Mean Difference (IV, Fixed, 95% CI)	0.10 [‐0.13, 0.33]
9.2 Fibrin sealant and collagen vs control	1	300	Mean Difference (IV, Fixed, 95% CI)	0.06 [‐0.06, 0.19]
9.3 Fibrin sealant vs collagen	1	62	Mean Difference (IV, Fixed, 95% CI)	0.07 [‐0.54, 0.68]
9.4 Fibrin sealant vs cyanoacrylate	1	30	Mean Difference (IV, Fixed, 95% CI)	0.11 [‐0.20, 0.43]
9.5 Oxidised cellulose vs cyanoacrylate	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.08 [‐0.35, 0.19]
9.6 Oxidised cellulose vs fibrin sealant	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.19 [‐0.45, 0.06]
10 Total hospital stay Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

10.1 Fibrin sealant vs control	1	82	Mean Difference (IV, Fixed, 95% CI)	‐0.5 [‐2.45, 1.45]
10.2 Fibrin sealant and collagen vs control	1	300	Mean Difference (IV, Fixed, 95% CI)	0.70 [‐1.83, 3.23]
10.3 Fibrin sealant vs cyanoacrylate	1	30	Mean Difference (IV, Fixed, 95% CI)	‐1.34 [‐3.61, 0.93]
10.4 Oxidised cellulose vs cyanoacrylate	1	30	Mean Difference (IV, Fixed, 95% CI)	‐0.67 [‐3.12, 1.78]
10.5 Oxidised cellulose vs fibrin sealant	2	80	Mean Difference (IV, Fixed, 95% CI)	0.25 [‐1.84, 2.33]
11 ITU stay Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

11.1 Oxidised cellulose vs fibrin sealant	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Operating time Show forest plot	5		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

12.1 Fibrin sealant vs control	2	122	Mean Difference (IV, Fixed, 95% CI)	‐14.55 [‐52.86, 23.76]
12.2 Fibrin sealant and collagen vs control	1	300	Mean Difference (IV, Fixed, 95% CI)	19.0 [2.09, 35.91]
12.3 Fibrin sealant vs collagen	1	62	Mean Difference (IV, Fixed, 95% CI)	‐4.0 [‐44.33, 36.33]
12.4 Oxidised cellulose vs fibrin sealant	1	50	Mean Difference (IV, Fixed, 95% CI)	5.40 [‐70.13, 80.93]

Comparison 5. Methods of dealing with cut surface

Ir a la tabla de la revisión

Comparison 6. Methods of vascular occlusion

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (perioperative) Show forest plot	14		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Continuous portal triad clamping vs control	1	15	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Intermittent portal triad clamping vs control	4	392	Odds Ratio (M‐H, Fixed, 95% CI)	0.63 [0.16, 2.44]
1.3 Continuous portal triad clamping vs continuous hepatic vascular exclusion	2	170	Odds Ratio (M‐H, Fixed, 95% CI)	3.39 [0.34, 33.33]
1.4 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.5 Continuous selective portal triad clamping vs continuous portal triad clamping	1	120	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.6 Intermittent portal triad clamping vs continuous portal triad clamping	2	121	Odds Ratio (M‐H, Fixed, 95% CI)	0.19 [0.02, 1.64]
1.7 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.8 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Odds Ratio (M‐H, Fixed, 95% CI)	2.93 [0.12, 74.00]
2 Serious adverse events (proportion) Show forest plot	8		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Intermittent portal triad clamping vs control	3	302	Odds Ratio (M‐H, Fixed, 95% CI)	1.16 [0.55, 2.44]
2.2 Continuous portal triad clamping vs continuous hepatic vascular exclusion	1	118	Odds Ratio (M‐H, Fixed, 95% CI)	0.68 [0.11, 4.22]
2.3 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Odds Ratio (M‐H, Fixed, 95% CI)	0.20 [0.01, 4.13]
2.4 Continuous selective portal triad clamping vs continuous portal triad clamping	1	120	Odds Ratio (M‐H, Fixed, 95% CI)	0.43 [0.19, 0.98]
2.5 Intermittent portal triad clamping vs continuous portal triad clamping	1	35	Odds Ratio (M‐H, Fixed, 95% CI)	0.47 [0.07, 2.96]
2.6 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Odds Ratio (M‐H, Fixed, 95% CI)	4.33 [0.46, 40.61]
3 Serious adverse events (number) Show forest plot	5		Rate Ratio (Fixed, 95% CI)	Subtotals only

3.1 Intermittent portal triad clamping vs control	1	100	Rate Ratio (Fixed, 95% CI)	1.50 [0.42, 5.32]
3.2 Continuous portal triad clamping vs continuous hepatic vascular exclusion	1	52	Rate Ratio (Fixed, 95% CI)	0.23 [0.03, 2.00]
3.3 Intermittent portal triad clamping vs continuous portal triad clamping	1	86	Rate Ratio (Fixed, 95% CI)	0.12 [0.01, 0.95]
3.4 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Rate Ratio (Fixed, 95% CI)	1.26 [0.53, 2.99]
4 Adverse events (proportion) Show forest plot	12		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 Intermittent portal triad clamping vs control	4	392	Odds Ratio (M‐H, Fixed, 95% CI)	1.27 [0.83, 1.94]
4.2 Continuous portal triad clamping vs continuous hepatic vascular exclusion	1	118	Odds Ratio (M‐H, Fixed, 95% CI)	0.89 [0.41, 1.96]
4.3 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Odds Ratio (M‐H, Fixed, 95% CI)	0.47 [0.20, 1.13]
4.4 Continuous selective portal triad clamping vs continuous portal triad clamping	1	120	Odds Ratio (M‐H, Fixed, 95% CI)	0.41 [0.19, 0.93]
4.5 Intermittent portal triad clamping vs continuous portal triad clamping	2	121	Odds Ratio (M‐H, Fixed, 95% CI)	0.67 [0.29, 1.56]
4.6 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.29, 2.52]
4.7 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Odds Ratio (M‐H, Fixed, 95% CI)	0.86 [0.42, 1.75]
5 Adverse events (number) Show forest plot	6		Rate Ratio (Fixed, 95% CI)	Subtotals only

5.1 Intermittent portal triad clamping vs control	2	226	Rate Ratio (Fixed, 95% CI)	1.19 [0.80, 1.76]
5.2 Continuous portal triad clamping vs continuous hepatic vascular exclusion	1	52	Rate Ratio (Fixed, 95% CI)	0.61 [0.29, 1.32]
5.3 Intermittent portal triad clamping vs continuous portal triad clamping	1	86	Rate Ratio (Fixed, 95% CI)	0.64 [0.31, 1.32]
5.4 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Rate Ratio (Fixed, 95% CI)	1.17 [0.72, 1.91]
6 Blood transfusion (proportion) Show forest plot	13		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Continuous portal triad clamping vs control	1	34	Odds Ratio (M‐H, Fixed, 95% CI)	0.08 [0.01, 0.80]
6.2 Intermittent portal triad clamping vs control	4	392	Odds Ratio (M‐H, Fixed, 95% CI)	0.82 [0.50, 1.35]
6.3 Continuous portal triad clamping vs continuous hepatic vascular exclusion	1	118	Odds Ratio (M‐H, Fixed, 95% CI)	5.66 [2.29, 14.00]
6.4 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Odds Ratio (M‐H, Fixed, 95% CI)	0.51 [0.24, 1.11]
6.5 Continuous selective portal triad clamping vs continuous portal triad clamping	1	120	Odds Ratio (M‐H, Fixed, 95% CI)	1.56 [0.42, 5.82]
6.6 Intermittent portal triad clamping vs continuous portal triad clamping	2	121	Odds Ratio (M‐H, Fixed, 95% CI)	1.14 [0.52, 2.49]
6.7 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Odds Ratio (M‐H, Fixed, 95% CI)	0.90 [0.36, 2.23]
6.8 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Odds Ratio (M‐H, Fixed, 95% CI)	0.58 [0.25, 1.36]
7 Blood transfusion (red blood cell) Show forest plot	10		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.1 Continuous portal triad clamping vs control	1	15	Mean Difference (IV, Fixed, 95% CI)	‐0.60 [‐3.20, 2.00]
7.2 Intermittent portal triad clamping vs control	1	100	Mean Difference (IV, Fixed, 95% CI)	‐1.5 [‐2.75, ‐0.25]
7.3 Continuous portal triad clamping vs continuous hepatic vascular exclusion	1	52	Mean Difference (IV, Fixed, 95% CI)	0.40 [‐1.61, 2.41]
7.4 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Mean Difference (IV, Fixed, 95% CI)	‐1.20 [‐2.38, ‐0.02]
7.5 Continuous selective portal triad clamping vs continuous portal triad clamping	1	120	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐0.31, ‐0.09]
7.6 Intermittent portal triad clamping vs continuous portal triad clamping	2	121	Mean Difference (IV, Fixed, 95% CI)	‐0.13 [‐0.60, 0.34]
7.7 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Mean Difference (IV, Fixed, 95% CI)	0.11 [‐0.23, 0.46]
7.8 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Mean Difference (IV, Fixed, 95% CI)	‐0.07 [‐0.45, 0.32]
8 Blood loss Show forest plot	16		Mean Difference (IV, Random, 95% CI)	Subtotals only

8.1 Continuous portal triad clamping vs control	3	131	Mean Difference (IV, Random, 95% CI)	‐0.24 [‐0.76, 0.27]
8.2 Intermittent portal triad clamping vs control	4	402	Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.19, 0.15]
8.3 Continuous portal triad clamping vs continuous hepatic vascular exclusion	2	170	Mean Difference (IV, Random, 95% CI)	0.17 [‐0.35, 0.68]
8.4 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Mean Difference (IV, Random, 95% CI)	‐0.25 [‐0.49, ‐0.00]
8.5 Continuous selective portal triad clamping vs continuous portal triad clamping	1	120	Mean Difference (IV, Random, 95% CI)	0.10 [‐0.19, 0.39]
8.6 Intermittent portal triad clamping vs continuous portal triad clamping	2	121	Mean Difference (IV, Random, 95% CI)	0.06 [‐0.20, 0.32]
8.7 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Mean Difference (IV, Random, 95% CI)	‐0.08 [‐0.20, 0.05]
8.8 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Mean Difference (IV, Random, 95% CI)	‐0.17 [‐0.74, 0.39]
9 Major blood loss (proportion) Show forest plot	3		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

9.1 Intermittent portal triad clamping vs control	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 Continuous selective portal triad clamping vs continuous portal triad clamping	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 Total hospital stay Show forest plot	10		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

10.1 Intermittent portal triad clamping vs control	4	402	Mean Difference (IV, Fixed, 95% CI)	0.32 [‐0.64, 1.28]
10.2 Continuous portal triad clamping vs continuous hepatic vascular exclusion	1	52	Mean Difference (IV, Fixed, 95% CI)	‐8.0 [‐13.05, ‐2.95]
10.3 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Mean Difference (IV, Fixed, 95% CI)	‐2.80 [‐4.13, ‐1.47]
10.4 Intermittent portal triad clamping vs continuous portal triad clamping	1	86	Mean Difference (IV, Fixed, 95% CI)	1.0 [‐2.82, 4.82]
10.5 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Mean Difference (IV, Fixed, 95% CI)	‐0.27 [‐1.60, 1.06]
10.6 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Mean Difference (IV, Fixed, 95% CI)	‐0.67 [‐2.40, 1.06]
11 ITU stay Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

11.1 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1		Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 Operating time Show forest plot	12		Mean Difference (IV, Random, 95% CI)	Subtotals only

12.1 Continuous portal triad clamping vs control	2	40	Mean Difference (IV, Random, 95% CI)	‐45.87 [‐95.61, 3.87]
12.2 Intermittent portal triad clamping vs control	2	176	Mean Difference (IV, Random, 95% CI)	25.66 [‐31.57, 82.89]
12.3 Continuous portal triad clamping vs continuous hepatic vascular exclusion	2	170	Mean Difference (IV, Random, 95% CI)	‐29.32 [‐82.75, 24.10]
12.4 Continuous selective hepatic vascular exclusion vs continuous portal triad clamping	1	160	Mean Difference (IV, Random, 95% CI)	‐7.20 [‐63.42, 49.02]
12.5 Continuous selective portal triad clamping vs continuous portal triad clamping	1	120	Mean Difference (IV, Random, 95% CI)	20.0 [‐0.00, 40.00]
12.6 Intermittent portal triad clamping vs continuous portal triad clamping	1	35	Mean Difference (IV, Random, 95% CI)	13.40 [‐41.28, 68.08]
12.7 Intermittent portal triad clamping vs continuous selective portal triad clamping	1	80	Mean Difference (IV, Random, 95% CI)	‐32.17 [‐51.50, ‐12.84]
12.8 Intermittent selective portal triad clamping vs intermittent portal triad clamping	2	138	Mean Difference (IV, Random, 95% CI)	8.64 [‐10.16, 27.45]

Comparison 6. Methods of vascular occlusion

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Comparison 7. Pharmacological interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (perioperative) Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 Recombinant factor VIIa vs control	1	185	Odds Ratio (M‐H, Fixed, 95% CI)	0.61 [0.13, 2.83]
1.2 Tranexamic acid vs control	1	214	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Serious adverse events (proportion) Show forest plot	3		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 Anti‐thrombin III vs control	1	24	Odds Ratio (M‐H, Fixed, 95% CI)	1.19 [0.20, 6.99]
2.2 Recombinant factor VIIa vs control	2	432	Odds Ratio (M‐H, Fixed, 95% CI)	1.10 [0.58, 2.09]
3 Serious adverse events (number) Show forest plot	3		Rate Ratio (Fixed, 95% CI)	Subtotals only

3.1 Recombinant factor VIIa vs control	2	432	Rate Ratio (Fixed, 95% CI)	1.46 [0.75, 2.84]
3.2 Tranexamic acid vs control	1	214	Rate Ratio (Fixed, 95% CI)	0.86 [0.31, 2.37]
4 Adverse events (proportion) Show forest plot	3		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

4.1 Anti‐thrombin III vs control	1	24	Odds Ratio (M‐H, Fixed, 95% CI)	0.53 [0.10, 2.84]
4.2 Recombinant factor VIIa vs control	1	232	Odds Ratio (M‐H, Fixed, 95% CI)	1.04 [0.34, 3.21]
4.3 Tranexamic acid vs control	1	214	Odds Ratio (M‐H, Fixed, 95% CI)	0.78 [0.36, 1.67]
5 Adverse events (number) Show forest plot	3		Rate Ratio (Fixed, 95% CI)	Subtotals only

5.1 Recombinant factor VIIa vs control	2	432	Rate Ratio (Fixed, 95% CI)	0.98 [0.87, 1.10]
5.2 Tranexamic acid vs control	1	214	Rate Ratio (Fixed, 95% CI)	0.78 [0.43, 1.42]
6 Blood transfusion (proportion) Show forest plot	5		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

6.1 Aprotinin vs control	1	97	Odds Ratio (M‐H, Fixed, 95% CI)	0.32 [0.12, 0.82]
6.2 Desmopressin vs control	1	60	Odds Ratio (M‐H, Fixed, 95% CI)	0.56 [0.12, 2.57]
6.3 Recombinant factor VIIa vs control	2	416	Odds Ratio (M‐H, Fixed, 95% CI)	0.94 [0.62, 1.43]
6.4 Tranexamic acid vs control	1	214	Odds Ratio (M‐H, Fixed, 95% CI)	0.02 [0.00, 0.40]
7 Blood transfusion (fresh frozen plasma) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

7.1 Desmopressin vs control	1	60	Mean Difference (IV, Fixed, 95% CI)	‐0.60 [‐1.39, 0.19]
8 Blood loss Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

8.1 Aprotinin vs control	1	97	Mean Difference (IV, Fixed, 95% CI)	‐0.44 [‐0.87, 0.00]
9 Hospital stay Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

9.1 Tranexamic acid vs control	1	214	Mean Difference (IV, Fixed, 95% CI)	‐1.0 [‐3.06, 1.06]
10 Operating time Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

10.1 Aprotinin vs control	1	97	Mean Difference (IV, Fixed, 95% CI)	‐1.0 [‐30.08, 28.08]

Comparison 7. Pharmacological interventions

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