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.

Background Diverticular disease of the colon has a high global prevalence. The guidelines suggest performing a colonoscopy 4-6 weeks after the acute episode to exclude colorectal cancer (CRC). However, these recommendations are based on old studies, when computed tomography was not used to diagnose acute diverticulitis (AD). There are currently some studies showing that CRC incidence is low in uncomplicated AD (UAD). Therefore, we decided to perform this study to determine the CRC incidence after an AD episode and the diagnostic efficacy of colonoscopy in these patients. Method This was a retrospective cohort study that included patients with AD between July 2016 and December 2017. Results One hundred seventy-four patients had AD. Of these, 46 patients were excluded and we analyzed 128 patients, 72 (56.3%) women and 56 (43.7%) men. Ninety (70.3%) had UAD and 38 (29.7%) complicated AD (CAD). The colonoscopy showed lesions in 18 (14.06%), 5 (3.9%) being CRC. The patients with CRC had shown CAD and were >70 years old (P=0.0001 and P=0.002 respectively). Conclusions Routine colonoscopy in patients with UAD appears not have many benefits as a diagnostic tool. However, it has a higher efficacy if the patients have CAD and are >70 years old.

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Cutaneous metastases are rare and when they appear they indicate an advanced disease, for that reason is important a high index of suspicion in patients at risk, for an early diagnosis.

Introducción: Las hernias lumbares representan el 2 % del total de hernias ventrales. La hernia de Petit pertenece al grupo de hernias lumbares congénitas ocupando el 10 % de estas. El defecto herniario es a nivel del triángulo lumbar inferior, limitado por la cresta ilíaca como base, el músculo oblicuo externo como borde lateral y el músculo dorsal ancho como borde medial. No existen reportes de la presencia de una apendicitis aguda dentro de una hernia de este tipo. Presentamos el caso de un paciente con apendicitis aguda en una hernia de Petit. Caso clínico: Hombre de 80 años de edad que inicia con cuadro de dolor abdominal persistente, inespecífico y difuso de 1 mes de evolución, acompañado de hipertermia no cuantificada, anorexia, dificultad para canalizar gases y estreñimiento. En la exploración física se encontró distención abdominal moderada, ruidos intestinales disminuidos, rebote positivo y resistencia muscular franca en todo abdomen. Se observo abultamiento en región lumbar derecha de 5 × 5 cm, duro y no reductible, muy doloroso a la palpación. Se estableció el diagnóstico hernia lumbar estrangulada y se programó exploración quirúrgica y hernioplastia lumbar, encontrando apéndice cecal con datos de inflamación aguda, abscedada y con plastrón de epiplón dentro de un saco herniario a través de un defecto herniario de Petit. Presentó además peritonitis purulenta generalizada, decidiendo realizar laparotomía exploradora para revisión y lavado del resto de la cavidad, apendicectomía y cierre primario del defecto aponeurótico por la contaminación. El estudio histopatológico mostró apendicitis aguda perforada (grado IV). Evolución favorable a un año del posoperatorio sin recidiva. Discusión: La apendicitis aguda asociada a una hernia de Petit resulta un diagnóstico excepcional.