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.
Background: Parasagittal meningiomas involving the superior sagittal sinus (SSS) pose formidable obstacles to surgical management. Invasion is often considered a contraindication to surgery because of associated morbidity, such as cerebral venous thrombosis.Aim of the work: was to evaluate the risk/benefit ratio in attempting radical excision of parasagittal meningiomas involving the superior sagittal sinus. Patients and methods:The study consisted of 25 patients who had undergone surgery for parasagittal meningioma. Patients with meningioma involving the anterior third of the sinus underwent radical removal. Patients with meningioma that was involving the middle and posterior third of the sinus had a radical removal if the sinus was completely obliterated, and subtotal removal of tumors that are infiltrating but not obliterating the SSS. Results: 23 patients (92%) had radical tumor resection achieving Simpson GI and 2 patients (8%) had subtotal tumor resection achieving Simpson GIV. There were 3 postoperative transient neurological deterioration (12%) and 2 postoperative deaths (8%).The recurrence rate in the study was 5%, with a follow-up for 24 months. Conclusion:The benefits must be carefully weighed against the risks deciding between more aggressive, radical, or less aggressive subtotal resections. The less aggressive subtotal resections if the sinus ispartially occluded may be a reasonable choice.
Background: low back pain (LBP) is related to disability and work absence and accounts for high economical costs. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. Failed back surgery syndrome is a common problem with enormous costs to patients, insurers, and society, defined as persistent back and/ or leg pain after spine surgery. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology. Aim of the Work: to evaluate the efficacy, safety and outcome of radiofrequency as a method for management of patients with chronic low back pain. Subjects and Methods: this prospective study was conducted at El Galaa Military Hospital starting from January 2017. Twenty-five patients with chronic low back pain with mal-response to medical treatment justified for receiving interventional pain management as a conservative method of treatment of low back pain. They were subjected to radiofrequency neurotomy as a method for managing low back pain. Results: there was highly statistically significant decrease in pain score immediately, 1 week, 1 month and 3 months than pain score before RF with p-value < 0.01and there was highly statistically significant difference between daily living activities before RF and daily living activities at different times of measurement with p-value < 0.01. Conclusion: low back pain is a medical, social and economical problem. Radiofrequency neurotomy had advantage regarding the long term follow up but the costs and equipment-wised problem still make it less prevailed. Recommendations: longer follow up and randomized study if could be conducted the results may indicate much clues.
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