Perioperative RBCT is independently associated with decreased OS and RFS following hepatectomy for CRLM. Interventions to minimize and rationalize the use of RBCT for hepatectomy are warranted to mitigate this detrimental effect on long-term outcomes.

Patients with elevated PHL in the initial postoperative period should be carefully monitored due to increased risk of major morbidity and mortality. Further research on the impact of lactate-directed fluid therapy is warranted.

Background: Many patients who sustain penetrating abdominal trauma can be man aged nonoperatively. The Eastern Association for the Surgery of Trauma (EAST) has published guidelines on selective nonoperative management (SNOM), and this approach is well established. The purpose of this study is to assess the management of penetrating abdominal trauma, including the selection of patients for SNOM and the use of this approach, at a Canadian level 1 trauma centre. Methods: We used the Hamilton Health Sciences trauma registry to compile data on patients aged 16 years and older who sustained penetrating abdominal trauma from Jan. 1, 2011, to Dec. 31, 2017. Hemodynamically stable, nonperitonitic patients with out evisceration or impalement were considered potentially eligible for SNOM. We compared the SNOM group of patients with the immediate operative (IOR) group. Our primary outcome was SNOM failure; secondary outcomes included length of stay, repeat imaging, computed tomography (CT) protocol, laparoscopy in left thoraco abdominal trauma, and nontherapeutic and negative laparotomies. Results: We included 191 patients with penetrating abdominal trauma; 123 underwent SNOM and 68 underwent IOR. Of the 68 patients in the IOR group, 4 underwent nontherapeutic laparotomies. Of the 123 patients in the SNOM group, this approach failed in 7 (5.7%). Patients who were successfully managed with SNOM had an average length of stay of 25.4 hours (7.9-43.0 h), with no repeat imaging in 34/35 (97.1%). Only 5 of the 47 patients with flank/back wounds had a CT scan that included luminal con trast. Only 3 of the 58 patients with left thoracoabdominal wounds underwent same admission laparoscopy, all demonstrating diaphragmatic defects. Conclusion: Our study demonstrates a high rate of compliance with the EAST SNOM guidelines, including minimal failure rate of SNOM and an efficient use of resources as demonstrated by reduced length of stay and minimal use of reimaging. We identified 2 opportunities for improvement: improved use of luminal contrast CT in patients with flank/back wounds and improved use of diagnostic laparoscopy in patients with left thoracoabdominal wounds. Contexte : Il est possible de traiter non chirurgicalement bon nombre de trauma tismes abdominaux pénétrant. L'Eastern Association for the Surgery of Trauma (EAST) a publié des lignes directrices sur une approche bien établie : le traitement non chirurgical sélectif (« selective nonoperative management », ou SNOM). Le but de cette étude est d'évaluer le traitement des traumatismes abdominaux pénétrants, y compris la sélection des patients en vue du SNOM et l'utilisation de cette approche dans un centre de traumatologie canadien de niveau 1. Méthodes : Nous avons utilisé le registre de traumatologie du Hamilton Health Sci ences Centre pour compiler les données sur les patients de 16 ans et plus ayant subi un traumatisme abdominal pénétrant entre le 1 er janvier 2011 et le 31 décembre 2017. Les patients hémodynamiquement stables, indemmes de péritonite, d'éviscération ou d'...