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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One of the most important and long recognised characteristics of tumour cells is their dysregulated cellular energetics with anaerobic driven glucose uptake. In patients with cancer the prognostic value of the systemic inflammatory response has been well established and the recent combination of PET and CT scanning combines the assessment of tumour physiological activity with detailed anatomical localisation. The aim of this study was to carry out a systematic review of the assessment of the relationship between both the tumour and host inflammatory responses using PETCT. An extensive literature review using targeted subject headings was carried out in the US National Library of Medicine, the Excerpta Medica database and Cochrane Database of Systematic Reviews until the 31st March 2018. On completion of the online search, the title and abstracts of each identified study was examined for relevance. Studies with duplicate datasets, not available in English and that did not have full text availability were excluded. Full texts of relevant articles were obtained and were then examined to identify any further relevant articles. Twelve studies containing 2,588 patients were included in the final analysis. All of the included studies used the FDG tracer in PETCT imaging and had biochemical assessment of the systemic inflammatory response. The majority of studies showed a direct relationship between the tumour and bone marrow glucose uptake and host systemic inflammatory responses as measured by C-Reactive Protein (CRP) ( = 2), albumin ( = 2), White Cell Count (WCC) ( = 3), neutrophils ( = 2) and platelets ( = 2). The majority of the studies ( = 8) also showed a direct relationship between tumour and bone marrow glucose uptake and poor outcomes. This review suggests a direct relationship between the tumour and bone marrow glucose uptake and host systemic inflammation. This may suggest new approaches for more optimal therapeutic targeting and monitoring strategies in patients with cancer.