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 Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

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Nutritional screening tools are mainly used to identify patients at risk of malnutrition. We aimed to compare commonly used nutritional tools in assessing the nutritional status of patients undergoing surgery for gastric cancer Methods: Consecutive patients undergoing surgery for gastric cancer between January 2017 and May 2019 were retrospectively evaluated from the comprehensive database. Nutritional Risk Screening-2002 (NRS), Malnutrition Universal Screening Tool, Subjective Global Assessment, Mini Nutritional Assessment-Short Form (MNA-SF), Malnutrition Screening Tool, and Short Nutritional Assessment Questionnaire scores were calculated for all patients. The assessment capabilities of these tools were compared using the European Society for Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria for malnutrition as the reference standard. The distinctive abilities of the tool risk groups were also evaluated using parameters reflecting nutritional status, including albumin, lymphocyte count, and fat-free mass index. Results: One hundred forty patients with the mean age of 64.2±11.8 years were analyzed, and 29 (20.71%) of whom were diagnosed as malnourished based on the ESPEN criteria. The strongest association (phi=0.62, large effect) and the highest agreement (kappa=0.59, moderate agreement) between tools and malnutrition were found for MNA-SF. This exhibited the highest specificity (0.84, 95% CI: 0.76 to 0.90), positive predictive value (0.58, 95% CI: 0.42 to 0.73), accuracy (0.84, 95% CI: 0.77 to 0.90), area under curve (0.850, 95% CI: 0.777 to 0.923), and diagnostic odds ratio (32.29, 95% CI: 10.02 to 104.04). Statistically significant decreases in all three parameters were observed only for the NRS risk groups. Additionally, MNA-SF exhibited a statistically significant decrease in the fat-free Amaç: Beslenme tarama araçları çoğunlukla malnutrisyon riski olan hastaları belirlemek için kullanılır. Bu çalışmada mide kanseri nedeniyle ameliyat planlanan hastaların beslenme durumlarını değerlendirmede sıklıkla kullanılan beslenme araçlarını karşılaştırmayı amaçladık. Yöntemler: Ocak 2017-Mayıs 2019 tarihleri arasında mide kanseri nedeniyle ameliyat olan hastalar, kapsamlı veri tabanından elde edilen bilgiler ile retrospektif olarak değerlendirildi. Tüm hastalar için Nutritional Risk Screening-2002 (NRS), Malnutrition Universal Screening Tool, Subjective Global Assessment, Mini Nutritional Assessment-Kısa Form (MNA-SF), Malnutrition Screening Tool, ve Short Nutritional Assessment Questionnaire araçlarının skorları hesaplandı. Bu araçların beslenme değerlendirme becerilerinin karşılaştırılmasında, referans standart olarak Avrupa Klinik Beslenme ve Metabolizma Derneği'nin (ESPEN) malnutrisyon tanı kriteri kullanıldı. Araçların risk gruplarını ayırt edici özellikleri ise albümin, lenfosit sayısı ve yağsız kitle indeksi gibi beslenme durumunu yansıtan parametreler kullanılarak değerlendirildi. Bulgular: Bu çalışmada yaş ortalaması 64.2±11.8 olan toplam 140 hasta analiz edildi ve bu hastaların 29'u (%20.71) E...