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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Opsoclonus–myoclonus paraneoplastic syndrome is a medical condition that includes opsoclonus along with diffuse or focal body myoclonus and truncal titubation with or without ataxia and other cerebellar signs. This rare neurological syndrome is poorly understood and can result in long-term cognitive, behavioral and motor sequelae. We report a case of a 49-year-old woman with anti-Ri antibody opsoclonus–myoclonus syndrome and an invasive ductal carcinoma with axillary nodes involvement. Following the diagnosis of opsoclonus–myoclonus syndrome, a multimodal immunotherapy treatment, with partial remission of the neurological symptoms. The patient underwent lumpectomy and axillary node dissection and the surgical pathology confirmed the diagnosis of breast cancer stage IIA. This was followed by chemotherapy, radiotherapy and hormone therapy with tamoxifen. At the 6 months follow-up there was a partial improvement, anti-Ri antibody was subsequently reported as negative and there was no evidence of disease recurrence.

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Tumores filóides são tumores raros da mama, correspondendo a menos de 1% de todos os neoplasmas mamários. Apresentam um comportamento biológico muito diverso (benigno, borderline, maligno) e, o seu tratamento baseia-se na exérese total da lesão. Material e Métodos: Revisão da literatura e processo clínico do doente. Caso Clínico: Mulher de 54 anos, encaminhada para a consulta de cirurgia geral por nódulo na mama direita, com crescimento rápido. Realizada biópsia da lesão que revelou tumor fibroepitelial benigno. A doente foi submetida a tumorectomia, cujo resultado anatomopatológico, foi tumor filóide borderline. Após 5 anos apresentou nódulo com dimensão superior a 5 centímetros na mama direita, biópsia confirmou recidiva local. Por volume mamário suficiente, foi proposta tumorectomia que a doente aceitou. Resultado anatomopatológico da peça determinou tumor filóide borderline com margens cirúrgicas inferiores a 1 cm. Proposto alargamento de margens com mastectomia simples e reconstrução mamária imediata com prótese, que a doente recusou, tendo sido submetida apenas a mastectomia simples. Resultado anatomopatológico final de peça cirúrgica de mastectomia sem tecido de neoplasia maligna. Conclusão: Os tumores filóides são tumores localmente agressivos, com crescimento rápido e com elevada capacidade de recidiva local, pelo que as margens cirúrgicas constituem um fator de prognóstico independente. Assim, sobretudo em tumores filóides de características borderline e maligno, margens cirúrgicas superiores ou iguais a 1 cm são recomendadas.