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.

PTNS is an ambulatory treatment that could play an important role in the context of a multimodal treatment approach in patients with LARS. It could be a first-line treatment to identify non-responders to conservative management who need different and more invasive treatments.

INTRODUCCIÓNLa colonoscopia es un procedimiento habitual utilizado en el diagnóstico, tratamiento y seguimiento de las enfermedades del colon. La perforación tras colonoscopia REV ESP ENFERM DIG (Madrid) Vol. 99. N.°10, pp. 588-592, 2007 Recibido: 30-03-07. Aceptado: 10-07-07. Correspondencia RESUMENObjetivo: el propósito de este estudio retrospectivo fue conocer la incidencia de perforaciones de colon por colonoscopia diagnóstica y terapéutica y valorar el manejo de las mismas en nuestro medio.Pacientes y método: se revisaron las perforaciones por colonoscopias realizadas en nuestro hospital entre enero de 1991 y diciembre de 2006. Se analizaron la finalidad del procedimiento, el mecanismo de la lesión, su presentación clínica y radiológica, el retraso diagnóstico, el estado general de los pacientes, el manejo terapéutico y sus resultados.Resultados: en el periodo de estudio hubo 15 perforaciones (0,09%) de un total de 16.285 colonoscopias realizadas (9 varones, 6 mujeres). Nueve ocurrieron tras colonoscopias diagnósticas y 6 terapéuticas. El 60% de las perforaciones fueron advertidas por el endoscopista durante el procedimiento (en el 88,6% de las diagnósticas y en el 16,6% de las terapéuticas). En el 73,7% de los casos el dolor con distensión abdominal fue el síntoma más frecuente y en 11 pacientes con pruebas de imagen se apreció gas extraluminal en el 100% de los casos. El retraso diagnóstico (> 24 horas) ocurrió en el 40% de los pacientes (rango: 1-6 días). Fueron intervenidos 12 pacientes (80%) de los que 4 eran ASA II y 8 ASA III/IV. La morbilidad postoperatoria fue del 44,44% y la mortalidad del 25%. La evolución de los pacientes tratados conservadoramente fue satisfactoria.Conclusión: la perforación de colon por colonoscopia es una complicación rara de consecuencias graves e incluso letales. El tratamiento conservador puede realizarse en casos seleccionados y bajo un control clínico estricto. El tipo de cirugía va a depender de la localización, tamaño de la lesión, patología colónica concomitante y grado de contaminación fecal. La mortalidad parece estar más relacionada con el estado general del paciente que con la propia técnica quirúrgica realizada.Palabras clave: Perforación colon. Colonoscopia. Complicaciones colonoscopia. ABSTRACTObjective: the aim of this retrospective study was to evaluate the incidence of colon perforations from diagnostic and therapeutic colonoscopies, and to assess their management in our hospital.Patients and method: perforations resulting from colonoscopy in our hospital were reviewed for the period January, 1991 to December, 2006. The study analyzed: purpose of procedure, lesion mechanisms, clinical and radiological presentations, delays in diagnosis, patient status, therapeutic handling, and outcome.Result: fifteen perforations (0.09%) (9 males and 6 females) out of a total of 16,285 colonoscopies carried out were seen to have taken place during the study period. Nine of these occurred after diagnostic colonoscopies, and 6 occurred after therapeutic endoscopies. Aroun...

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AIMTo analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.METHODSA review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.RESULTSThis is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.CONCLUSIONA series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.