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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Suspected adverse reactions (SARs) reported for Cartrophen Vet (100 mg sodium pentosan polysulphate/ml) to the Veterinary Medicines Directorate in the UK for the period January 1991 to October 1999 were reviewed. Of the 161 reports, 28 were probably product related, 54 were possibly product related, 71 were unlikely to be related and eight were unclassified. An estimated real incidence of adverse reactions probably and possibly associated with Cartrophen Vet of 0.074 per cent on an individual dose basis was calculated (assuming only 10 per cent were documented due to underreporting). Sixty-two SARs (38.5 per cent) documented emesis, 22 (35.5 per cent) of which were product related (onset five to 15 minutes after administration). Sixty-eight SARs (42.2 per cent) documented general changes to demeanour, 10 (14.7 per cent) were product related (lethargy and/or mild depression and/or mild inappetence lasting up to two days after administration). Six SARs were considered likely to be associated with concurrently administered carprofen. Cartrophen Vet had a low incidence of side effects that were mild and transitory.