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.

Conjoint twins have always been a surgical challenge. The authors report an unusual finding in a surviving epigastric heteropagus twin. A 17 year old boy who underwent laparotomy for acute intestinal obstruction revealed a blind ending but complete duplication of the large bowel and an accessory liver in the falciform ligament, along with a separate gall bladder but with fused bile ducts.The findings suggest that the duplicated bowel loop and the accessory liver were remnants of the incomplete parasite twin, assimilated into the body of the autosite, which remained asymptomatic for 17 years. This case is being reported because of the uniqueness of the finding.A 17 year old boy was referred in January 2002 with features of acute intestinal obstruction. He gave a history of surgery in childhood, details of which were not available at that time. Examination showed a grossly distended abdomen with a 15 6 10 cm scar over the upper abdomen. Hernial sites and external genitalia were normal. Auscultation showed absent bowel sounds.Biochemical and haematological parameters were normal. Abdominal radiography showed multiple air-fluid levels suggestive of intestinal obstruction. Ultrasound of the abdomen showed a dilated bowel loop and a suspected duplication of the liver and gall bladder.Exploratory laparotomy showed the abdomen to be filled with a distended large bowel loop that was densely adherent to the parietus. Further exploration revealed the abdomen to be in two compartments and separated by a layer of thick membrane.The anterior compartment contained an enormously dilated and distended loop of large intestine measuring about 150 cm in length and 5-15 cm wide and ending blindly at both ends. It had a glistening surface with areas of haemorrhage and multiple congested blood vessels (fig 1). The lumen was filled with yellowish non-feculent fluid. The mucosa appeared flattened with multiple ulcers and whitish specks. Attached fatty tissue showed multiple lymph nodes and one of them appeared yellowish white with a cord-like structure. No mesentery or any definite vascular pedicle was seen. There was no evidence of any connection to the underlying normal bowel. The posterior compartment contained the normal stomach, small gut, and large bowel with normal peristaltic activity.Further exploration revealed an accessory lobe of liver within the falciform ligament, separate from the normal liver (fig 2).There was a large vascular pedicle, which when traced, was seen to arise from the right hepatic artery of the normal liver. Two distinct gall bladders were also observed. However, there was fusion of the bile ducts at the common bile duct level. The rest of the viscera were normal. The duplicated large bowel was excised in toto.Histopathological and microscopic examination of the resected specimen showed a dilated segment of large intestine with ulceration and inflammation of the wall. Lymph nodes in the fatty tissue showed reactive changes. The yellowish white cord-like structure showed attached testicular tissue with predo...

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