Using data to understand outcomes for cancer surgery in low- and middle-income countries

Abstract

BACKGROUND: Of the 15.2 million individuals diagnosed with cancer worldwide in 2015, 80% had a need for surgery. Yet little comparative data globally exist on early outcomes, particularly within low-income and middle-income countries (LMICs). I designed and delivered an international, prospective cohort study to provide comprehensive data across income settings on early outcomes in patients undergoing surgery for three common cancers. METHODS: I determined the early outcomes following cancer surgery through standardised and prospective methodology to gather contemporaneous and comprehensive data across multiple countries. Next, I validated this data to ensure accuracy and high case ascertainment. Finally, I determined the patient- and hospital-level factors which influence early outcomes following cancer surgery, to identify potential interventions which may improve surgical cancer care worldwide. RESULTS: In an international cohort of 15 958 patients from 428 hospitals and 82 countries undergoing surgery for breast, colorectal, or gastric cancer, case ascertainment and data accuracy were high. Higher postoperative mortality was seen in patients receiving surgery in LMICs, despite equivalent complication rates. The capacity to rescue patients from death after the development of common postoperative complications explains some of the disproportionate mortality burden experienced in LMICs. I demonstrated improvements in hospital facilities, which correlate with a hospital’s ability to perform safe, high-quality operations and aid the early identification and treatment of postoperative complications, are likely to prevent up to three early surgical deaths for every 100 patients undergoing cancer surgery worldwide. CONCLUSIONS: Perioperative mortality is disproportionately greater in LMICs, which contributes to worse cancer survival in these settings. Excess early mortality following cancer surgery is avoidable, but improving access to surgical care alone is unlikely to significantly reduce cancer-associated mortality. Urgent assessment of pragmatic perioperative interventions led by investigators in LMICs is needed to avert avoidable mortality after the development of common complications after cancer surgery

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This paper was published in Edinburgh Research Archive.

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