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.

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Background: endoscopic electroexcision is the standard technique for the removal of colorectal polyps. However, it is associated with the postoperative morbidity. In order to reduce the incidence of complications, “cold” excision seems to be an alternative option.Aim: to improve the results of endoscopic treatment for patients with colorectal polyps.Patients and methods: from September 2019 to September 2020, 160 patients ≥ 18 years old (80 in each group), who underwent endoscopic removal of colorectal polyps ≤ 10 mm in size by cold excision (132 lesions) and traditional polypectomy (129 lesions), were included in a prospective randomized trial. All removed specimens were studied histologically with an assessment of the resection margins (R0/R1). The analysis of the postoperative complications after endoscopic polypectomy and the incidence of Rx resection after removal of polyps by both techniques was done.Results: the compared groups were homogenous in the number of patients, gender, age, and comobridities. There were no significant differences in the number of removed polyps, their site and the type according to endoscopic classifications. The operation time was significantly higher in the conventional polypectomy group compared with the “cold” one (p = 0.0001). There were no significant differences in the intraoperative complications rate between the two groups (p = 0.06). There were no postoperative complications in the “cold” group. In the control group postoperative complications occurred after 12 out of 129 polyps removal (p = 0.001). The univariate analysis showed that a risk factor for the development of postoperative complications after conventional polypectomy is the lack of submucosal lifting (OR: 15.3, 95% CI: 1.9-125.6, p = 0.01). Histopathology of the removed specimens showed that in both groups most of the procedures were considered as R0 resections (54% in the main group, 56.4% in the control group, p = 0.8). The polyp size ≤ 4 mm identified as a risk factor for R1, Rx resection (OR: 2.4, 95% CI: 1.3–4.7, p = 0.007).Conclusion: “cold” polypectomy is an effective and safe method and may be recommended as an alternative technique for the removal of non-pedunculated colorectal polyps ≤ 10 mm.

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