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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Background: Previous studies have confirmed the association between biliary disease and bariatric operations. Biliary complications may include cholecystitis, biliary pancreatitis, cholangitis, biliary polyps, biliary sludge and gallstones. It is believed that cholelithiasis is the result of increased biliary stasis due to alterations in the enterohepatic circulation and hormonal changes associated with weight loss. However, research regarding predictive factors other than the percentage of excess weight loss (EWL) is limited. In addition, preventive measures of gallstone formation and potential related complications are still debated. Aim: The goal of this article is to assess the predictive factors of biliary complications after laparoscopic sleeve gastrectomies (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to review the possible need for future surveillance via radiological studies. Method: ology: A retrospective review of 118 patients who underwent LSG and LRYGB between 2015 and 2016 in Jordan University Hospital (single centre) was performed in order to complete this cohort study. Patients with previous cholecystectomies or biliary disease prior to bariatric operations were excluded from the study. Utilizing the hospital's electronic records system, patients were contacted by telephone and were asked a series of questions listed in a custom-made questionnaire. Results: Mean age ± SD was 34.9 ± 12.0 years old (68.64% Females). Eleven patients (9.32%) underwent LRYGB, 100 patients underwent LSG and seven patients underwent both, with a preoperative mean body mass index (BMI) ± SD of 45.2 ± 6.3. 29 patients (24.58%) developed postoperative biliary complications. The main biliary complications were as follows: biliary pancreatitis (0.85%), biliary polyps (0.85%), biliary sludge (0.85%), cholecystitis/gallstones (22.03%). Conclusion: In conclusion, it was found that approximately 24.58% of patients have post-operative late biliary complications. Of these patients, predictive factors other than EWL were not significant enough to recommend prophylactic screening via radiological studies. Highlights