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.

Objectives: Penetrating abdominal trauma is one of the injuries that could affect civilians in wartime. This retrospective study investigates the commonly injured abdominal organs, and the impact of multiple injured organs on mortality. Methods: We reviewed the operating room (OR) logs of patients who presented to the surgical emergency department (SED) at Al-Mouwasat University Hospital with war-related abdominal penetrating trauma requiring exploratory laparotomy between April 1, 2011 and December 31, 2017. Results: Of 7826 patients with traumatic injuries, 898 patients (11.5%) required exploratory laparotomy. Of all patients who had an exploratory laparotomy (n = 898), 58 patients (6.5%) died in the perioperative period. Regarding complete laparotomies (n = 873 patients), small intestines, large intestines, and liver were the most commonly affected organs (36.4%, 33%, 22.9%, respectively). A total of 92 patients (10.2%) had negative laparotomy in which all the abdominal organs were not injured. The perioperative mortality rate (POMR) increased when more organs/organ systems were injured per patient reaching a peak at 3 organs/organ systems injuries with a POMR of 8.3%. POMR was highest in patients with musculoskeletal injuries (18.2%), followed by vascular injuries (11.8%), and liver injuries (7%). Conclusions: The management of civilians’ abdominal injuries remains a challenge for general and trauma surgeons, especially the civilian trauma team. The number and type of injured organs and their correlation with mortality should be considered during surgical management of penetrating abdominal injuries.

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There is no difference between laparoscopic or open approaches concerning specimen's length, distal margin, circumferential margin, and total and positive lymph nodes. Laparoscopic rectal resection is not only technically feasible but it seems also oncologically safe.

Introduction and importance The breast angiosarcoma is a rare malignant vascular neoplasm; it represents nearly 0.05% of all breast cancers. Clinically, it could look like a haemangioma or pseudoangiomatous hyperplasia. Here, we report a case of a primary angiosarcoma of the breast (PAB) that mimics a giant fibroadenoma in physical examination and ultrasound features. Case presentation A 22 year-old woman came to our hospital complaining of a mobile non-tender mass in her right breast. It was monitored for a while until it became an 8 × 7 cm 2 . Past medical and family histories were unremarkable. Ultrasonography showed a well circumscribed hypoechoic lobular mass. The wide excision was performed and the pathological study showed angiosarcoma. The patient was re-operated for total mastectomy, screened for distant Metastases and followed-up closely for one year. Clinical discussion Fibroadenoma-like lesions are not uncommon and physicians should pay an attention for any breast mass even in the patient who is young and has no risk factors of the traditional breast cancer. PAB is used to be missed in the clinical practice over the world; it is extremely rare and is proved by Immunohistochemistry. The full management could be totally completed by a mastectomy with/out axillary node dissection. Conclusion The primary angisarcoma of the breast (PAB) could resemble a fibroadenoma in pre-operative investigations. In many reviews, PAB mimicked many diseases. Thus, the medical literature needs more case reports and series to identify an ideal protocol of diagnosis and management.