BACCHUS: A randomised non-comparative phase II study of neoadjuvant chemotherapy (NACT) in patients with locally advanced rectal cancer (LARC)

BACKGROUND

Chemoradiation (CRT) or short-course radiotherapy (SCRT) are standard treatments for locally advanced rectal cancer (LARC). We evaluated the efficacy/safety of two neoadjuvant chemotherapy (NACT) regimens as an alternative prior to total mesorectal excision (TME).

METHODS/DESIGN

This multi-centre, phase II trial in patients with magnetic resonance imaging (MRI) defined high-risk LARC (>cT3b, cN2+ or extramural venous invasion) randomised patients (1:1) to FOLFOX + Bevacizumab (Arm 1) or FOLFOXIRI + bevacizumab (Arm 2) every 14 days for 6 cycles prior to surgery. Patients were withdrawn if positron emission tomography (PET) standardised uptake value (SUV) after 3 cycles failed to decrease by >30% or increased compared to baseline. Primary endpoint was pathological complete response rate (pCR). Secondary endpoints included adverse events (AE) and toxicity. Neoadjuvant rectal (NAR) scores based on "T" and "N" downstaging were calculated.

FINDINGS

Twenty patients aged 18-75 years were randomised. The trial stopped early because of poor accrual. Seventeen patients completed all 6 cycles of NACT. One stopped due to myocardial infarction, 1 poor response on PET (both received CRT) and 1 committed suicide. 11 patients had G3 AE, 1 G4 AE (neutropenia), and 1 G5 (suicide). pCR (the primary endpoint) was 0/10 for Arm 1 and 2/10 for Arm 2 i.e. 2/20 (10%) overall. Median NAR score was 14·9 with 5 (28%), 7 (39%), and 6 (33%) having low, intermediate, or high scores. Surgical morbidity was acceptable (1/18 wound infection, no anastomotic leak/pelvic sepsis/fistulae). The 24-month progression-free survival rate was 75% (95% CI: 60%-85%).

INTERPRETATION

The primary endpoint (pCR rate) was not met. However, FOLFOXIRI and bevacizumab achieved promising pCR rates, low NAR scores and was well-tolerated. This regimen is suitable for testing as the novel arm against current standards of SCRT and/or CRT in a future trial.

Electrodegradation of naphthalenic amines: Influence of the relative position of the substituent groups, anode material and electrolyte on the degradation products and kinetics

The electrodegradation of the 4-aminonaphthalene-1-sulfonic acid (4AN1S), 5-aminonaphthalene-2-sulfonic acid (5AN2S) and 8-aminonaphthalene-2-sulfonic acid (8AN2S) was studied, using two electrode materials as anode, BDD and Ti/Pt/PbO₂, and two different electrolytes, sodium sulfate and sodium chloride. The highest COD removal rates were obtained at BDD: for 5AN2S and 8AN2S results were similar in both electrolytes; for 4AN1S, results were better in sodium chloride. The lowest COD removal rates were obtained at the system Ti/Pt/PbO₂-sodium sulfate, for all the studied amines. The dissolved organic carbon (DOC) removal was much higher at BDD for all the amines, in sulfate for 5AN2S and 8AN2S and in chloride for 4AN1S. Nitrogen removal was always almost irrelevant in sulfate medium but higher than 60%, after 6-h assays, in chloride. The highest combustion efficiencies were attained at the system BDD-sodium sulfate and were: 4AN1S-75%; 5AN2S-84%; 8AN2S-74%. HPLC results show that total degradation of the studied aminonaphthalene sulfonates is attained at both anode materials, utilizing any of the electrolytes, with a first order kinetics. However, kinetic constants obtained with the variation of the amines concentration in time are 10-40 times higher in chloride, being slightly higher at Ti/Pt/PbO₂ than at BDD. Regarding the presence of carboxylic acids during the degradation assays, it was observed that the electrolysis of the amines 5AN2S and 8AN2S always lead to higher amounts of oxalic acid and lower quantities of acetic acid than the electrolysis of the amine 4AN1S.

Immediate function dental implants inserted with less than 30N·cm of torque in full-arch maxillary rehabilitations using the All-on-4 concept: retrospective study

The aim of this retrospective clinical study was to evaluate the short-term implant success rate and marginal bone loss in full-arch fixed prosthetic maxillary rehabilitations supported by implants in immediate function with the All-on-4 treatment concept placed with insertion torque of <30N·cm or ≥30N·cm. This study included 83 patients (69 female, 14 male) with 332 implants placed (120 inserted with <30N·cm and 212 inserted with ≥30N·cm) who were treated between January 2010 and March 2013. Outcome measures were implant success and marginal bone loss at 1year of follow-up. Ten patients (12.0%; 13 implants inserted with <30N·cm and 27 implants with ≥30N·cm) were lost to follow-up. The cumulative implant success rate was 97.5% at the patient level, and 98.3% for implants inserted with <30N·cm and 97.5% for implants inserted with ≥30N·cm. The mean±standard deviation marginal bone loss at 1year was 1.14±0.38mm for implants inserted with <30N·cm and 1.39±0.49mm for implants inserted with ≥30N·cm (significant difference; P<0.001, Wilcoxon signed rank test). These results indicate that implants with insertion torques of <30N·cm may render comparable success rates and marginal bone loss at 1year compared to implants inserted with insertion torques of ≥30N·cm.

Preparation, characterization and environmental applications of Sr1 - x (La,Bi) x TiO3 perovskites immobilized on Ni-foam: photodegradation of the Acid Orange 7

The Sr_1 - x La _x TiO₃ (0 ≤ x ≤ 0.4) and Sr_1 - x Bi _x TiO₃ (0 ≤ x ≤ 0.3) perovskites were prepared via solid state reaction by partially replacing the Sr²⁺ ions in the SrTiO₃ structure by La³⁺ or Bi³⁺ ions, characterized and utilized as photocatalysts immobilized in Ni-foam substrate in the degradation of the azo dye Acid Orange 7 (AO7). For both perovskite families, the XRD data reveal the existence of a predominant well-crystallized phase, belonging to a cubic perovskite in a Pm3m space group, with the presence of other minority phases. The characteristic dimension and the volume of the cell decrease with the introduction in the SrTiO₃ lattice of the La³⁺ or Bi³⁺ ions. The grain size of the Sr_1 - x La _x TiO₃ samples is around 100 nm and slightly lower for the Sr_1 - x Bi _x TiO₃ samples. Regarding the utilization of the prepared perovskite powders deposited over the Ni-foam substrates as catalysts in the photodegradation of AO7 solutions, the results show an improvement in the performance of the films of the substituted perovskite when compared to the SrTiO₃ perovskite, being the best results obtained with Sr_0.9Bi_0.1TiO₃.

Neuropsychiatric Symptoms in Fahr's Syndrome

Objectives and methodology

To review the neuropsychiatric symptoms of Fahr's syndrome.

Results/discussion

Fahr's Syndrome is a rare degenerative neuropsychiatric condition, characterized by bilateral and symmetrical calcifications of the basal ganglia. It can be associated with several metabolic, infectious or genetic conditions. It is clinically manifested by movement disorders, psychosis, cognitive impairment, mood disorders, personality dysfunction or obsessive-compulsive spectrum disturbances. First presentation can be psychiatric in approximately 40% of the cases. Cognitive dysfunction, mood disorders and psychosis are the most common presentations. In the present case, depression, dementia and movement disorders were the main clinical pictures. This report alerts for the significance of neuropsychiatric symptoms within this diagnosis, considering the multisystemic approach of the illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Selective hypersensitivity to cefazolin and contribution of the basophil activation test

The authors present 2 case reports of selective cefazolin hypersensitivity: a 49 year-old woman with a history of two perioperative reactions (urticaria and severe anaphylaxis) after the use of rocuronium, propophol and cefazolin; a 36 year-old pregnant woman who developed facial erythema, lips angioedema and hypotension immediately after administration of ropivacain, sufentanil, cefazolin, oxytocin and ephedrine. In both cases, intradermal skin tests were positive for cefazolin. A basophil activation test was performed for cefazolin, which was positive in one patient. Oral challenge tests with penicillin, amoxicillin and other cephalosporins were negative. This selective hypersensitivity to cefazolin may be associated with a R1-side chain different from other beta-lactams.

Communication: On the first ionization threshold of the C2H radical

The slow photoelectron spectrum of the ethynyl radical has been recorded for the first time by using the DESIRS beamline of the SOLEIL synchrotron facility. Ethynyl was generated using a microwave discharge flow tube. The observation of the X⁺Π3←XΣ+2 transition allowed the first direct measurement of the adiabatic ionization threshold of this radical (E_I = 11.641(5) eV). The experimental results are supported by ab initio calculations. Our preliminary investigation of the cationic ground state potential energy surfaces predicts a non-negligible Renner-Teller effect which has not been discussed previously.

[Central nervous system lymphoma revealed by lymphocytic meningitis in a patient with systemic lupus erythematosus: An unusual association]

INTRODUCTION

We report an unusual observation of central nervous system (CNS) lymphoma in a 60-year-old woman with systemic lupus erythematosus and fatal outcome.

OBSERVATION

The patient had systemic erythematosus lupus for 7 years, treated with mycophenolate mofetil and developed lymphocytic meningitis in 2015 associated to the presence of EBV in the cerebrospinal fluid and a necrotic vermis' lesion. Diagnosis of large B-cell lymphoma was histologically confirmed from stereotaxic biopsy, shortly before she died from neurological complications.

CONCLUSION

Even though the current association is unusual, lymphocytic meningitis with hypoglycorrachia in patients with systemic lupus erythematosus may reveal CNS lymphoma and diagnosis confirmation requires stereotaxic biopsy in order not to delay specific therapeutic management.

Surgical morbidity and clinical outcomes in ovarian cancer - the role of obesity

OBJECTIVE

To evaluate the effect of body mass index on the surgical outcomes in ovarian cancer patients. In addition, we performed a systematic review to compare our outcomes with the current literature.

DESIGN

Retrospective cohort study and a systematic review of the literature.

SETTING

Gynaecology department at the Royal Cornwall Hospital Trust.

POPULATION

Surgically managed stage I-IV ovarian cancer patients between September 2006 and September 2014.

METHODS

Primary and secondary outcome measures were evaluated across BMI categories; BMI <25 kg/m², BMI 25–29.9 kg/m², BMI ≥30 kg/m² and BMI ≥40 kg/m². A systematic review was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

MAIN OUTCOME MEASURES

The primary outcome measure was surgical complications. Secondary outcome measures were other intra- and postoperative outcomes.

RESULTS

Two hundred twenty-eight women were included in the study, of which 84 had a BMI <25 kg/m², 84 women had a BMI 25–29.9 kg/m², and 60 women were obese (BMI ≥30 kg/m²), 13 of whom were morbidly obese. Morbid obesity was associated with increased rates of wound complications. However, BMI did not show an association with other outcomes. In the review, an increasing BMI was associated with increased rates of wound complications and prolonged hospital stay, but did not impact other surgical outcomes.

CONCLUSION

Obesity is associated with increased rates of wound complications and a prolonged hospital stay, but does not appear to affect other operative outcomes including cytoreduction status and 30-day mortality. Therefore, operative management and postoperative care require a multifactorial approach to minimise adverse outcomes.

Disrupted trabecular bone micro-architecture in middle-aged male HIV-infected treated patients

OBJECTIVES

HIV-infected individuals are at increased risk of incident fractures. Evaluation of trabecular bone micro-architecture is an important tool to assess bone strength, but its use has not yet been reported in middle-aged HIV-infected male individuals. The aim of the study was to compare bone micro-architecture between HIV-infected and HIV-uninfected men.

METHODS

In this cross-sectional study, 53 HIV-infected male individuals with a mean (± standard deviation) age of 49 ± 9 years who had been receiving antiretroviral therapy including tenofovir disoproxil fumarate (DF) for at least 60 months were compared with 50 HIV-uninfected male controls, matched for age and ethnic origin. We studied the volumetric bone density and micro-architecture of the radius and tibia using high-resolution peripheral quantitative computed tomography (HR-p QCT).

RESULTS

Volumetric trabecular bone density was 17% lower in the tibia (P < 10(-4) ) and 16% lower in the radius (P < 10(-3) ) in HIV-infected patients compared with controls. By contrast, the cortical bone density was normal at both sites. The tibial trabecular micro-architecture differed markedly between patients and controls: bone volume/total volume (BV/TV) and trabecular number were each 13% lower (P < 10(-4) for both). Trabecular separation and inhomogeneity of the network were 18% and 24% higher in HIV-infected patients than in controls, respectively. The radial BV/TV and trabecular thickness were each 13% lower (P < 10(-3) and 10(-2) , respectively). Cortical thickness was not different between the two groups.

CONCLUSIONS

The findings of lower volumetric trabecular bone density and disrupted trabecular micro-architectural parameters in middle-aged male HIV-infected treated patients help to explain bone frailty in these patients.

Malignant catatonia and neuroleptic malignant syndrome: How different/similar are they?

Introduction

Catatonia is a neuropsychiatric syndrome that appears in medical, neurological or psychiatric conditions. There are presentation variants: “malignant catatonia” (MC) subtype shares many characteristics with the neuroleptic malignant syndrome (NMS), possibly reflecting common pathophysiology.

Objectives/methods

We present a clinical vignette and review the literature available on online databases about MC/NMS.

Results

We present a man, 41-years-old, black ethnicity, with no relevant medical history. He had two previous episodes compatible with brief psychosis, the last one in 2013, and a history of adverse reactions to low doses of antipsychotics. Since the last episode he was asymptomatic on olanzapine 2.5 mg id. He acutely presented to the Emergency Room with mutism, negativism, immobility and delusional speech, similar to the previous episodes mentioned and was admitted to a psychiatric infirmary, where his clinical condition worsened, showing muscle rigidity, hemodynamic instability, leukocytosis, rhabdomyolysis and fever. Supportive care was provided, olanzapine was suspended and electroconvulsive therapy (ECT) was initiated. After two months, he was discharged with no psychotic symptoms. He is still under ECT and no antipsychotic medication was reintroduced.

Discussion/conclusion

Many studies suggest that clinical or laboratory tests do not distinguish MC from NMS and that they are the same entity. These two conditions are life-threatening and key to treatment is a high suspicion level. There is no specific treatment; supportive care and stopping involved medications are the most widely used measures. ECT is a useful alternative to medication.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Case Report of Charles Bonnet Syndrome – The Silent Doubt: Am i Crazy?

Introduction

The Charles Bonnet syndrome refers to symptoms of visual hallucinations that occur in patients with visual acuity or visual field loss. These are often called release hallucinations, reflecting the most widely accepted theory about their pathogenesis. The syndrome is most found in elderly patients, 70–85 years, and this probably reflect the mean age at which the most common underlying conditions are seen. It is probably more common than is thought and because either it is misdiagnosed as psychosis and/or dementia or it is not reported by patients because they fear that the hallucinations represent psychiatric disease.

Objective and method

The authors present the clinical case of a 89-year-old woman, with no previous psychiatric disease, admitted to hospital because of visual hallucinations in form of children and animals. She experienced them during months until she told someone. No psychiatric symptoms were found. The lady had a serious cataract on the left eye with total loss of the visual acuity, as documented by ophthalmologic examination.

Results

The patient initiated quetiapine 300 mg and will have period appointments with a neurologist. Further future information will be presented.

Conclusions

A correct diagnosis is essential to treat these patients and explaining them the meaning of the hallucinations is generally relieving. Many author disagree with antipsychotic agents, while others report benefit.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Trichotillomania in delusional infestation

Introduction

Trichotillomania is described as a recurrent failure to resist impulses to pull out hairs. It is usually associated with obsessive-compulsive disorder and body dismorphic disorder. It is usually confined to one or two sites in the body.

Objective

The aim of our work is to describe a case of delusional infestation with secondary trichotillomania and briefly review the theoretical aspects of this clinical presentation.

Methods

We searched online databases and reviewed current case reports published, using the keywords “delusional infestation”, “Ekbom syndrome” and “trichotillomania” and compared similarities in the presentation, development and outcome. We present a clinical vignette of a 38-year-old female, with no relevant psychiatric history. The patient developed severe itching that she believed was caused by bugs that lived inside her hair follicles, so she pulled out completely all of her eyebrows, eyelashes, pubic and underarms hairs. She maintained some hair on her head, that she repeatedly pulled out and proceeded to break in order to kill the bugs. She claimed to have absolutely no itchiness in the hairless areas of her body.

Results

The patient was referred to psychiatric consultation and was started on oral antipsychotics but, as the review from literature suggested, the clinical evolution only became satisfactory when an antidepressant (SSRI) was added.

Conclusion

Although, trichotillomania is more commonly seen in clinical practice in association with other psychiatric disorders, it may also present itself as a symptom of delusional activity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The late-onset bipolar disease: A case report

The prevalence of bipolar disorder after 65 years is 0.1 to 0.4%. Mania represents 4.6% to 18.5% of all psychiatric admissions in geriatrics in the USA. It has some specificity in terms of clinical presentation, evolution, prognosis and treatment.

We report the case of a patient who presented a first manic episode after 65 years. E.H, AP, 67 years old, single, without personal and familial psychiatric history, addressed to psychiatric emergencies for psychomotor agitation and euphoric mood. He presented two months ago a manic access with almost total insomnia, euphoria, psychomotor agitation and delusions of grandeur. The balance sheet reveals no incorrections (blood count, thyroid balance, serology: TPHA, VDRL, hepatitis B and C, HIV). The cerebral CT was normal. The patient has been received a quetiapine 200 mg/day, olanxapine 10 mg/day and valproate 1000 mg/day. The evolution after three weeks was favorable.

The late-onset bipolar disorder is characterized by: a less intense euphoria, replaced by anger and irritability, a more elements of persecution, disinhibiting and impulsivity. Respecting to that, this case is an exception. The most common confounding symptoms and behavioral disorders. A higher frequency of neurological diseases is noted in elderly subjects with a bipolar disorder and, so, a neuropsychiatric rigorous evaluation is fundamental to exclude the possibility of an organic pathology for the manic access. The prescription of psychotropic drugs in the elderly must be under monitoring.

Disclosure of interest The authors have not supplied their declaration of competing interest.

Electrochemical oxidation of humic acid and sanitary landfill leachate: Influence of anode material, chloride concentration and current density

The influence of applied current density and chloride ion concentration on the ability of Ti/Pt/PbO2 and Ti/Pt/SnO2-Sb2O4 anodes for the electrochemical oxidation of humic acid and sanitary landfill leachate samples was assessed and compared with that of BDD anode. For the experimental conditions used, results show that both organic load and nitrogen removal rates increase with the applied current density and chloride ion concentration, although there is an optimum COD/[Cl-]0 ratio below which there is no further increase in COD removal. Metal oxide anodes present a similar performance to that of BDD, being the results obtained for Ti/Pt/PbO2 slightly better than for Ti/Pt/SnO2-Sb2O4. Contrary to BDD, Ti/Pt/PbO2 promotes lower nitrate formation and is the most suitable material for total nitrogen elimination. The importance of the optimum ratio of Cl-/COD/NH4 +initial concentrations is discussed.

Sugar and volatile fatty acids dynamic during anaerobic treatment of olive mill wastewater

Biogas production has been the main route used to exploit olive mill wastewater (OMW), after pretreatment and/or in combination with other effluents, but more recently the production of chemicals and biopolymers by biotechnological routes has deserved increasing attention by the scientific community. The present paper aims to explore the potential of fresh OMW as a source of volatile fatty acids (VFAs) and biogas. The time profile of VFAs production and the corresponding sugar consumption was followed by high-performance liquid chromatography, in batch anaerobic assays. The experimental results have revealed the very high potential of the OMW for the production of VFAs, mainly due to the high sugar concentration in the effluent (37.8 g/L) and its complete conversion into VFAs, in a time period of 2-3 days. The most abundant VFAs were acetic (48-50%), n-butanoic (12-27%), iso-pentanoic (12-14%) and propanoic (5-13%). The ratio of VFA containing even and odd carbon chains increased with the reduction in the initial chemical oxygen demand concentration of the samples used in the experiments. The conversion of the VFAs to biogas was inhibited at concentrations of 3.5 g/L of VFAs.

Bevacizumab and Combination Chemotherapy in rectal cancer Until Surgery (BACCHUS): a phase II, multicentre, open-label, randomised study of neoadjuvant chemotherapy alone in patients with high-risk cancer of the rectum

BACKGROUND

In locally advanced rectal cancer (LARC) preoperative chemoradiation (CRT) is the standard of care, but the risk of local recurrence is low with good quality total mesorectal excision (TME), although many still develop metastatic disease. Current challenges in treating rectal cancer include the development of effective organ-preserving approaches and the prevention of subsequent metastatic disease. Neoadjuvant systemic chemotherapy (NACT) alone may reduce local and systemic recurrences, and may be more effective than postoperative treatments which often have poor compliance. Investigation of intensified NACT is warranted to improve outcomes for patients with LARC. The objective is to evaluate feasibility and efficacy of a four-drug regimen containing bevacizumab prior to surgical resection.

METHODS/DESIGN

This is a multi-centre, randomized phase II trial. Eligible patients must have histologically confirmed LARC with distal part of the tumour 4-12 cm from anal verge, no metastases, and poor prognostic features on pelvic MRI. Sixty patients will be randomly assigned in a 1:1 ratio to receive folinic acid + flurourcil + oxaliplatin (FOLFOX) + bevacizumab (BVZ) or FOLFOX + irinotecan (FOLFOXIRI) + BVZ, given in 2 weekly cycles for up to 6 cycles prior to TME. Patients stop treatment if they fail to respond after 3 cycles (defined as ≥ 30 % decrease in Standardised Uptake Value (SUV) compared to baseline PET/CT). The primary endpoint is pathological complete response rate. Secondary endpoints include objective response rate, MRI tumour regression grade, involved circumferential resection margin rate, T and N stage downstaging, progression-free survival, disease-free survival, overall survival, local control, 1-year colostomy rate, acute toxicity, compliance to chemotherapy.

DISCUSSION

In LARC, a neoadjuvant chemotherapy regimen - if feasible, effective and tolerable would be suitable for testing as the novel arm against the current standards of short course preoperative radiotherapy (SCPRT) and/or fluorouracil (5FU)-based CRT in a future randomised phase III trial.

TRIAL REGISTRATION

Clinical trial identifier BACCHUS: NCT01650428.

[Prevalence of granulomatous lesions in minor salivary gland biopsy in a case series of 65 patients with tuberculosis]

PURPOSE

The distinction between tuberculosis (TB), a worldwide infectious granulomatosis requiring specific antibiotic therapy, and sarcoidosis, a rare granulomatous disease that may require corticosteroids is not straightforward and may result in diagnostic and therapeutic delay.

METHODS

We prospectively and consecutively evaluated the presence of epithelioid granulomas in minor salivary gland biopsy of 65 consecutive patients with TB.

RESULTS

In our study, 10.8 % of our TB patients had epithelioid granulomas without caseous necrosis identified in their minor salivary gland biopsy, regardless of the location of TB, HIV status and whether or not the sputum examination was positive for tuberculous bacilli.

CONCLUSION

The presence of epithelioid granulomas in minor salivary gland biopsy may not be helpful to the clinician to rule out TB in a patient with suspected sarcoidosis.

Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications)

BACKGROUND

There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.

METHODS

Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications.

RESULTS

Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05).

CONCLUSIONS

This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.