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J Surg Oncol. 2018 Dec;118(8):1237-1242. doi: 10.1002/jso.25286. Epub 2018 Oct 31.

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

Author information

1
Department of Surgery, University of Virginia, Charlottesville, Virginia.
2
Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts.
3
Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
4
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
5
Department of Surgery, Centre Hospitalier Universitaire de Butare, Butare, Rwanda.
6
Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda.
7
Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.
8
Ministry of Health, Kigali, Rwanda.
9
Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennyslavia.
10
Department of Global Health and Social Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

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.

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.

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).

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.

KEYWORDS:

Africa; Rwanda; cancer surgery; gastric cancer; low resource

PMID:
30380140
PMCID:
PMC6250579
[Available on 2019-12-01]
DOI:
10.1002/jso.25286
[Indexed for MEDLINE]

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