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.

Amyand’s hernia refers to an inguinal hernia which contained the vermiform appendix in the hernia sac. It is more commonly found on the right side in relation to anatomical location of the vermiform appendix and left – sided Amyand’s hernia is very rare. Herein, we report a case of left – sided Amyand’s hernia with bowel obstruction in a 1 year 4 months old boy. The left groin mass was firm and tender, with skin erythema. However, the mass could not be completed incarcerated into the abdominal cavity. His abdomen was distended with sluggish bowel sound. A diagnosis of intestinal obstruction secondary to obstructed left inguino – scrotal hernia was made, and laparotomy was performed. During laparotomy, transverse skin incision was made on the upper abdomen, and the left inguinal canal was opened in accordance with the usual inguinal hernia repair. The hernia sac contained the appendix, caecum and twisted terminal ileal loops. Small bowel resection with primary anastomosis was performed with left herniorrhaphy. Appendix was preserved due to its normal appearance. He remained well during follow up with no hernia recurrence and testicular atrophy Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 449-453