Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien–Dindo I–II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien–Dindo III–V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054–2.061,p= 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066–1.472,p= 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081–1.502,p= 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128–1.664,p= 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175–1.664,p≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509–5.894,p= 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.
与高收入国家相比，妇科恶性肿瘤在中低收入国家女性中的发病率显著偏高，而全球癌症治疗在可及性、质量和结局方面的差异尚不明确。本研究旨在评估高收入国家与中低收入国家在妇科肿瘤手术后并发症发生率及死亡率方面的国际差异。研究设计为一项多中心国际前瞻性队列研究，纳入接受妇科恶性肿瘤手术的女性患者（临床试验注册号NCT04579861）。采用多水平逻辑回归分析，在患者-医院/国家的三级嵌套模型中确定相关关系。研究共纳入来自27个国家73家医院的1820例患者。中低收入国家与高收入国家的轻微并发症（Clavien-Dindo I-II级）发生率分别为26.5%（178/672）和26.5%（267/1009），而严重并发症（Clavien-Dindo III-V级）发生率分别为8.2%（55/672）和7%（71/1009）。较高的轻微并发症发生率与术前机械性肠道准备（OR=1.474，95%CI=1.054-2.061，p=0.023）、手术时间延长（OR=1.253，95%CI=1.066-1.472，p=0.006）及术中失血量增加（OR=1.274，95%CI=1.081-1.502，p=0.004）相关。较高的严重并发症发生率与手术时间延长（OR=1.37，95%CI=1.128-1.664，p=0.002）、失血量增加（OR=1.398，95%CI=1.175-1.664，p≤0.001）以及主刀医生资历相关，其中低年资医生发生严重并发症的风险是高年资医生的三倍（OR=2.982，95%CI=1.509-5.894，p=0.002）。在所有手术中，中低收入国家与高收入国家分别有50%和25%的手术由低年资医生完成。本研究结论表明，中低收入国家与高收入国家在术后严重并发症发生率方面无显著差异。提升手术并发症救治能力是实现有效干预的重要着力点。
肿瘤(癌症)患者之家