Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.
Introduction. Minimally invasive techniques in colorectal surgery have become increasingly popular and are considered a standard of care in most surgical cenres. Locating the tumour during laparoscopic procedure can be technically challenging. Incorrect localization of the primary lesion may lead to a non-radical resection margin. The technique of endoscopic tattooing (ET) prior to surgery or endoscopic treatment is considered a useful tool. Various dyes can be used for this purpose, such as: Indian ink, methylene blue, indigocarmine, toluidine blue, isosulfan blue, haematoxylin and eosin, indoxin green. This procedure is recommended by international scientific societies (ASGE and ESGE).Objective. The purpose of the study is to review the current literature on the use of ET in large intestine tumour lesions. Materials and method. A MEDLINE literature search of English language articles addressing the use of ET to enable intraoperative tumour localization in colorectal surgery was performed to evaluate and summarize the feasibility of this technique.Results. The use of ET enables the easy and safe localization of colorectal tumurs during minimally invasive colorectal procedures. The percentage of complications is insignificant. Conclusions. The available literature proves the safety and benefits of using the ET prior to surgical or endoscopic treatment. ASGE and ESGE recommend the use of ET in marking tumours before surgical treatment, and the area after endoscopic resection for further evaluation.
Introduction. Achalasia is a most frequent primary motility disorder of the oesophagus with the prevalence of 10/100,000 individuals, with no gender predominance. Due to its rare occurrence, at the early stages may be erroneously diagnosed, leading to progression of disease and delayed treatment. Objectives. The main aim of the review is to depict current data about achalasia, including pathogenesis, diagnosis, and possible treatment modalities, particularly the latest, minimally invasive technique: per-oral endoscopic myotomy (POEM). State of knowledge. The ethology of achalasia remains unknown, although autoimmune, viral or neurodegenerative causes may be considered triggers of the disease. In some cases, achalasia may be secondary to other conditions (e.g. malignancy, Chagas disease). Typical symptoms of achalasia are dysphagia (for both liquids and solids), regurgitations, heartburn and weight loss. The diagnosis is based on endoscopy, oesophageal high-resolution manometry (HRM) and X-ray with barium swallow. Therapies used in the treatment of achalasia focus on improving food passage by reducing LES pressure. These procedures include pharmacologic treatment, pneumatic balloon dilation, Heller myotomy and endoscopic myotomy. POEM was first introduced in humans by Inoue in 2008. Recent studies have revealed excellent short-term outcome of POEM with no serious complications. Conclusion. Achalasia is an incurable disease; however, available therapies can effectively reduce patients` symptoms. Further evaluation may lead to the establishment of tailored-to-patient treatment, and it is believed that POEM will become a gold standard for treatment of achalasia.
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