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:Recurrence and reflux are 2 most important remote complications of lap-paraesophageal hernia (PEH) repair. However, the extent of recurrence remains unknown. We sought to determine the true incidence of recurrence after lap-PEH repair.Methods:A meta-analysis was carried out. PubMed, EMBASE, Cochrane Library, hand search, and personal communication were used to access and appraise studies. The inclusion criteria were full-text papers published from 1991 to date that describe lap-PEH repair in >25 patients, have at least a 6-month follow-up, and address the issue of recurrence. “Wrap migration” papers were excluded. Papers were appraised and the data were isolated on summary sheets. MS Office Excel 2003 was used to plot the results and represent it in graphs.Results:Thirteen studies were eligible (all retrospective case series). A total of 965 patients with 99 recurrences were noted. The overall recurrence rate (in all patients) was 10.2% and was 14% if only the followed up patients (n=658/965) were considered. However, when patients with objective evidence (follow-up Ba esophagogram) were used (301/965), the “true” recurrence rate was 25.5% (ie, 1 in 4 recurred). The learning curve did not appear to be an issue (P=0.27). The studies revealed broad 95 CI and touched the line-of-no-effect, thereby increasing the “chance factor.” When an alternate model was applied, esophageal lengthening (by Collis-Nissen gastroplasty) revealed a significant protective influence (P<0.0001).Conclusion:The true incidence of lap-PEH recurrence is 25.5%. The learning curve is not an adequate explanation. Mandatory (protocol) follow-up esophagograms at 1 year are essential. Two emphasis points in the repair have emerged: hiatoplasty and (superadded) esophageal lengthening.

DC-LC is safe and feasible in non-acute patients with symptomatic cholelithiasis. Over-55y age group had a higher chance of admission, mainly due to caution.

This article highlights the clinical effectiveness of wound edge protector devices (WEPD) in preventing the post-operative surgical site infections (SSI) in patients undergoing abdominal surgery. Using the principles of meta-analysis and systematic review as recommended by the Cochrane Collaboration, the data from selected randomized, controlled trials (RCTs) were analysed to generate summated outcome and presented in the form of odds ratio (OR). Eighteen RCTs on 3808 reported the effectiveness of WEPD in patients undergoing abdominal surgery. The use of WEPD was associated with the reduced incidence of overall SSI (OR 0.59; 95% CI 0.43-0.81; z = 3.30; p < 0.001) and superficial SSI (OR 0.42; 95% CI 0.18-0.95; z = 2.09; p < 0.04). In addition, WEPD also successfully reduced the risk of SSI in clean-contaminated wounds (OR 0.67; 95% CI 0.46-0.98; z = 2.06; p < 0.04) as well as in contaminated wounds (OR 0.24; 95% CI 0.12-0.49; z = 3.96; p < 0.0001). WEPD seems to be an effective intervention to reduce the risk of post-operative SSI in patients undergoing abdominal surgery.

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