Serum Albumin as a Predictor of Survival after Interval Debulking Surgery for Advanced Ovarian Cancer (AOC): A Retrospective Study.

OBJECTIVE: To investigate the impact of serum albumin (at diagnosis and pre-operatively) on survival in patients undergoing cytoreductive surgery for advanced ovarian cancer(AOC) and whether improvement in albumin achieved following neoadjuvant chemotherapy (NACT) affects overall survival (OS). METHODS: Outcomes of 441 patients who underwent cytoreduction for AOC were reviewed. Albumin was recorded at diagnosis and pre-operatively. Further analysis was performed if patients were hypoalbuminaemic at diagnosis.Analysis was stratified according to whether the patientreceived primary debulking surgery (PDS) or interval debulking surgery (IDS) and if their albumin was corrected. RESULTS: 308 patients had a serum albumin level at diagnosis and 400 patients had a pre-operative albumin available for analysis. For patients with an albumin at diagnosis ≤ 35g/L and ≥36 g/L, median OS was 31.5 (95% CI 23.5-39.5) and 50.4 (95% CI 38.9-61.9) months respectively (P = 0.003). Followingmultivariate analysis (MVA), albumin at diagnosis remained statistically significant as an independent marker for survival, even after adjusting for cytoreductive outcome, stage and grade(p = 0.04, Hazard ratio 1.38, 95% CI 1.01-1.89).Hypoalbuminaemic patients at diagnosis achieved complete cytoreduction in 53% of cases.For PDS patients, median OS was 19.7 months (95% CI 11.5-27.9). For IDS patients, median OS was 27.9 months (n = 1).IDS patients with a corrected albumin had a median OS of 42.9 months (95% CI 31.5-54.3) (p > 0.05). CONCLUSION: Hypoalbuminaemia at diagnosis is a poor prognostic factor in AOC. Normalization of serum albumin after NACT is a potential predictor of survival.

Long-Term Outcomes and Quality of Life at More than 10 Years After Laparoscopic Roux-en-Y Gastric Bypass Using Bariatric Analysis and Reporting Outcome System (BAROS).

INTRODUCTION: Literature on long-term (> 10 years) outcomes in terms of weight loss, resolution of co-morbidities, and quality of life (QoL) after bariatric surgery is limited. The aim of this study was to investigate the excess weight loss (EWL), resolution of comorbidities, and QoL more than 10 years after laparoscopic Roux-en-Y gastric bypass (LRYGB) using the Bariatric Analysis and Reporting Outcome System (BAROS). METHODS: Data on patient demographics, weight, body mass index (BMI), comorbidities, type of surgery, complications, and QoL were collected from a prospectively maintained database. RESULTS: A total of 92 patients out of 104 who underwent LRYGB during the study period and completed a median follow-up of 130 months were successfully contacted. The median age was 48 years (IQR 42-54 years) and 85.9% had a BMI of more than 40. The median excess weight loss (EWL) was 46.5% (IQR 27.9-64.3%). Type 2 diabetes mellitus reduced from 56.5 to 23.9% (p < 0.001), hypertension from 51.1 to 39.1% (p = 0.016), and obstructive sleep apnoea from 33.7 to 12.0% (p < 0.001). Participants reported feeling better (median 0.2, IQR 0.2-0.4), engaging in more physical activity (0.1, IQR 0.1-0.3), having more satisfactory social contacts (0.4, IQR 0.2-0.5), a better ability to work (0.3, IQR - 0.1-0.5), and a healthier approach to food (0.2, IQR - 0.3-0.3) at the end of follow-up. CONCLUSION: LRYGB leads to positive outcomes in terms of weight loss, reduction in comorbidities, and improvement in QoL at a follow-up of more than 10 years.

On a knife-edge: clinical uncertainty with an extensive knife blade in situ in the craniofacial region.

A 25-year-old man presented to the trauma department following a penetrating stab wound to his left infraorbital margin with retained knife blade causing superoposterior displacement of the globe. Plain skull X-ray revealed an extensive retained blade with subsequent CT imaging revealing the tip of the blade had reached the right styloid process with no neurovascular compromise. Initial concern was primarily for the left eye leading to ophthalmology being the first specialty requested to review the patient. However, once the extent of the injury was established, ophthalmology requested further review from maxillofacial, ENT and neurosurgery. This resulted in an 84 hours wait between the initial injury and the removal of the knife blade. Incredibly, the patient had no initial sequelae from such an extensive injury and had an unremarkable recovery with no further complications aside from a laceration to the left inferior rectus muscle that was conservatively managed.