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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Representing 90–95% of all malignant gallbladder neoplasms, adenocarcinoma is by far the most common subtype. Adenosquamous carcinoma is a rare subtype, accounting for only 1–5% of all gallbladder carcinomas. These tumors have been shown to have aggressive biologic behavior, commonly extending to adjacent structures. Some studies have shown that the squamous component often displayed a greater proliferative capacity than the adenocarcinomatous component (possibly even up to twice as fast). Complete surgical resection is currently the mainstay of treatment but the prognosis is often poor. In this paper, we present a case of a 69-year-old male with an AJCC Stage IV moderately differentiated adenosquamous carcinoma of the gallbladder treated with radical cholecystectomy including liver segments IVb, V, VI.

In 2019, Pancreatic cancer became the third leading cause of cancer related mortality in the United States of America. Pancreatic cancer is a fatal malignancy that is predominantly seen in men with advanced age with aggressive course. Ninety percent of cases are adenocarcinoma. Pancreatic adenocarcinoma is very difficult to detect as is usually asymptomatic with no early signs. At least 80% of tumors are unresectable by the time of diagnosis. Despite substantial improvement in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since 1960s. Multidisciplinary therapy with a combination of chemotherapy, radiation and surgery performed at high volume centers remains the best chance for cure. We report a rare case of a small T1 pancreatic head carcinoma with underlying chronic pancreatitis presenting with cancerous pericardial effusion and tamponade. Despite the small size of the primary tumor, the extensive pattern of lymphatic occlusion can lead to mesenteric and mediastinal lymphatic spread to the pericardium. US guided emergent pericardiocentesis was performed with removal of 750 cc of serosanguinous fluid. Cytopathological examination of the fluid revealed poorly differentiated pancreatic adenocarcinoma. A Port-A-Cath was placed, and he was referred to the oncology department to start chemotherapy.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs of the small bowel are rare, and often present with an abdominal mass and/or bleeding. Chemotherapy and surgery are the mainstay of therapy. Here, we discuss an unusual case of a ruptured jejunal GIST with hemoperitoneum and recurrence despite surgical excision followed by Imatinib treatment. Forty-five cases of ruptured small intestinal GISTs were identified in the literature. Most cases were in males and were found to be at the site of the jejunum.

Giant inguinal hernias are defined as inguinal hernias that extend below the midpoint of the inner thigh when the patient is in the standing position or an anteroposterior diameter of at least 30 cm or a laterolateral diameter of ~50 cm with non-reducibility for >10 years. This article presents a 39-year-old male with a five-year history of a giant left inguinal hernia that was treated with left inguinal hernia repair with mesh, orchiectomy, complicated scrotoplasty, intraoperative ultrasound and aspiration of 3.9 L of fluid from the hernia sac. Surgical repair of giant inguinal hernias can be challenging and is associated with a variety of complications. Various modalities have been described to assist in hernia reduction including debulking, or, as in this case, aspiration of the hernia sac and a preperitoneal incision. Although the Lichtenstein tension free repair is commonly used, no standard approach has been accepted.

Endometriosis is classically defined as ‘the presence of endometrial glands and stroma outside of the uterine cavity and musculature’. Although it most commonly occurs in the pelvis, various extrapelvic locations have been reported in the literature. There seems to be a strong association between abdominal wall endometriomas and previous surgical scars. In female patients presenting with a cyclically painful abdominal wall mass, a high index of suspicion for endometrioma must be maintained, especially in the setting of previous gynecologic surgery. Although there may be a role for medical management of symptoms, the most definitive treatment of an abdominal wall endometrioma appears to be wide local excision with negative margins. This paper presents a 39-year-old female with an extensive gynecologic surgical history presenting with a 6 × 6 cm cyclically tender abdominal wall endometrioma treated with wide local excision.

Ascites, pelvic mass and elevated CA-125 in females carry a grim prognosis, likely an ovarian carcinoma. However, more benign etiologies such as Meigs’ and pseudo-Meigs’ syndrome must be considered. Pseudo-Meigs’ syndrome presenting with an elevated CA-125 is rare and presents a diagnostic challenge. Medline and PubMed were queried for pseudo-Meigs’ syndrome cases. We present a 35-year-old female patient who presented with abdominal swelling and weight gain. Imaging demonstrated a 29-cm large intraabdominal mass with significant ascites with elevation of CA-125. Surgical resection was performed, and pathology identified uterine leiomyoma. Twenty-one cases of pseudo-Meigs’ syndrome were identified in the literature. Most patients presented with abdominal distention, and some also reported dyspnea. All patients, including our case, were treated surgically. No recurrence reported among these cases. Surgery is the mainstay for radical treatment in pseudo-Meigs’ syndrome. Resolution of the ascites and hydrothorax occurs following resection of the tumor.