Background There is no consensus on how to best achieve a low central venous pressure during hepatectomy for the purpose of reducing blood loss and red blood cell (RBC) transfusions. We analyzed the associations between intraoperative hypovolemic phlebotomy (IOHP), transfusions, and postoperative outcomes in cancer patients undergoing hepatectomy. Methods Using surgical and transfusion databases of patients who underwent hepatectomy for cancer at one institution (11 January 2011 to 22 June 2017), we retrospectively analyzed associations between IOHP and RBC transfusion on the day of surgery (primary outcome), and with total perioperative transfusions, intraoperative blood loss, and postoperative complications (secondary Maher Al Khaldi and Filip Gryspeerdt-Co-first authors, equal contribution.

In the pregnant patient, HCA represents a significant diagnostic and therapeutic challenge. Anatomically favorable located lesions can be safely managed with laparoscopic liver resection. We suggest that laparoscopic liver resection should be considered as part of the currently available strategies for HCA during pregnancy.

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multilocular abscesses (Type III) had significantly lower failure rates following algorithmic approach with primary surgical treatment (3/32) compared to first-line antibiotics or percutaneous drainage (24/80) (9.3% versus 30.0%, p=0.021) with no 30-day mortalities for either group. Large unilocular abscesses (Type II) failed first-line percutaneous drainage in 25.5% (13/51), with 10 patients requiring escalation to surgery. Treatment of Type II abscesses with primary surgery rather than percutaneous drainage was successful in 88.2% (15/17) with no 30-day mortalities. Conclusion: Primary surgical intervention is highly successful in the treatment of large pyogenic liver abscesses. While antibiotic therapy remains the mainstay of treatment for small acute liver abscesses, in light of higher failure rates for percutaneous drainage we propose that surgical intervention should be considered for select patients with large complex abscesses as up-front definitive treatment.

Background: Spontaneous rupture of liver tumors, such as hepatocellular adenoma (HCA) and carcinoma (HCC), is rare but might lead to a potentially life-threating situation, as unspecific symptoms can be misleading. However, immediate interventional or surgical intervention is required to stop the bleeding. Methods: A female 53-year old patient was admitted to the hospital with unspecific epigastric pain for the past three days. Successful emergency angiographic embolization was accomplished with gelatin foam powder in the hemodynamically stable patient. Subsequent magnetic imaging (MRI) revealed the most likely diagnosis of an HCA, which had ruptured and a two additional adenomas witch less than 3cm in diameter in segments 4 and 6. We performed a single-incision laparoscopy to evacuate the hematoma and to address the ruptured liver tumor. Anatomical left lateral sectionectomy was performed. The resected liver lobe was removed via the umbilical single-port incision Results: The postoperative course was uneventful and the patient could be discharged on postoperative day 5. Conclusion: With the high probability of a benign lesion to be resected at the site of rupture and the additional lesions without an immediate indication for surgical removal, it was safe to perform the resection laparoscopically instead of a major open resection. In our opinion, benefits of routine laparoscopic liver surgery should also be taken into account in emergency settings.

34 Background: Half of patients with colorectal cancer develop liver metastases during the course of their disease. Surgery is the only potentially curative option for CRLM if resectable. Treatment of patients over 70 years old is challenging mainly because of comorbidities and other geriatric syndromes. Thus, we intended to report our experience with elderly patients with resectable CRLM. Methods: After approval by the Institutional Review Board (IRB), all records from a prospectively collected database at Centre Hospitalier de l’Université de Monréal (CHUM) were retrospectively analyzed. Clinicopathological characteristics, surgery and chemotherapy treatment modalities were reviewed. RFS and OS in patients ≥ 70y were calculated using the Kaplan Meier survival curve. Results: From 2010 to 2016, 101 patients older than 70 years were identified. Safety and surgical complications were previously reported. Median age was 75 years. CRLM were synchronous in 46.5% and metachronous in 53.5%. Relapse free survival (RFS) of patients ≥ 70 years was 33.7 months. Overall survival (OS) of patients ≥70 years was comparable to those of less than 65 years old (median OS: 56 vs 62 months; p = 0.15, respectively). Hepatic relapse showed worse survival when compared to extra-liver recurrence, mOS: 44 vs 33.2 vs 29.3 months for non-hepatic, hepatic only and hepatic with other sites respectively (trend p = 0.034). Although non-statistically significant, Patients with metachronous CRLM had superior mOS compared to those with synchronous disease (58.7 vs 44.7 months; p = 0.22). Conclusions: Survival Outcomes of patients with an age ≥ 70 years were comparable to those of younger patients and what is reported in literature. Age should not be a limiting factor in the management of elderly patients with resectable CRLM. Hepatic metastatectomies +/- chemotherapy should be offered with curative intents.