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Impact of delayed care on surgical management of patients with gastric cancer in a low-resource setting.

Impact of delayed care on surgical management of patients with gastric cancer in a low-resource setting.

Authors :
Martin AN
Silverstein A
Ssebuufu R
Lule J
Mugenzi P
Fehr A
Mpunga T
Shulman LN
Park PH
Costas-Chavarri A
Source :
Journal of surgical oncology [J Surg Oncol] 2018 Dec; Vol. 118 (8), pp. 1237-1242. Date of Electronic Publication: 2018 Oct 31.
Publication Year :
2018

Abstract

Background: Gastric cancer is the fifth most common cancer in Eastern Africa. Diagnostic delays in low-resource countries result in advanced disease presentation. We describe perioperative management of gastric cancer in Rwanda.<br />Methods: A retrospective review of records at three hospitals was performed to identify gastric adenocarcinoma cases from January 2012 to June 2016. Multiple perioperative and tumor-related variables were collected. Descriptive and bivariate analyses were performed.<br />Results: The final analysis included 229 patients with gastric cancer. Median age was 58 years (interquartile range [IQR] 49-65) and 49.6% were female (n = 114). Patients reported symptoms (ie, weight loss, epigastric pain) for a median time of 12 months (IQR 7.5-24). On presentation, 18.8% ( n = 43) had gastric outlet obstruction; 13.5% ( n = 31) had a palpable mass. Fifty-one percent ( n = 117) underwent an operation; of these, 74% ( n = 86) received gastrojejunostomy or were inoperable; and 29% ( n = 34) underwent curative resection. Palliative care referrals were made for 9% ( n = 20). Pathology reports were available for 190 patients (83.0%). Only 11.3% ( n = 26) had Helicobacter pylori ( H. pylori) testing of which 65.4% tested positive ( n = 17).<br />Conclusions: A majority of patients presented with advanced disease. Very few patients had a curative resection. Significant advances in diagnosis and treatment are needed to improve the care of gastric cancer patients in Rwanda.<br /> (© 2018 Wiley Periodicals, Inc.)

Details

Language :
English
ISSN :
1096-9098
Volume :
118
Issue :
8
Database :
MEDLINE
Journal :
Journal of surgical oncology
Publication Type :
Academic Journal
Accession number :
30380140
Full Text :
https://doi.org/10.1002/jso.25286