Clinical epidemiology and mortality risk factors of gastric cancer in a sub-Saharan African setting: a retrospective analysis of 120 cases in Yaoundé (Cameroon).

INTRODUCTION: in sub-Saharan Africa, there is scare published data on cancer in general and gastric cancer in particular. METHODS: we conducted a multicenter retrospective analysis of the medical records of patients followed for gastric cancer in 5 hospital departments in the city of Yaoundé (Cameroon) over 6 years. RESULTS: we recorded a total of 120 patients with a mean age of 53.4 ± 13.7 years. There were 62 females (51.7%). The most common risk factors for gastric cancer in our patients was Helicobacter pylori infection (59 cases, 49.1%). Seventy-six patients (63.3%) consulted within 1 to 6 months of symptoms on set at the forefront of which chronic epigastralgia (74.1%). At endoscopy, the tumor was mostly located at the antrum and was locally advanced or metastatic in 25.8% and 58.4 of cases respectively. Adenocarcinoma was the main histologic type found in 105 (87.5%) cases. Curative treatment could only be implemented in 26.7% of patients. We noted a total of 85 deaths (70.8%) with a mean survival time of 5.91 ± 7.51 months. Survival rate at 3 and 5 years was 10.1% and 4.6%, respectively. On multivariable analysis, variables independently associated with overall survival included: WHO stage 3 performance status (p = 0.042), palpable epigastric mass on examination (p = 0.042), pyloric localization (p = 0.007), and liver metastasis (p = 0.012). CONCLUSION: clinical epidemiology of gastric cancer in our study is comparable to those of other African studies with a predominance of locally advanced/metastatic forms. Prognosis is grim with diagnostic delay behind all of the identified mortality risk factors.

A laparoscopy-assisted surgical approach to esophageal carcinoma.

BACKGROUND: Surgical resection is the treatment of choice for esophageal carcinoma. Over the past decade, laparoscopy has proven an accurate staging modality for detecting peritoneal carcinosis and small metastatic liver deposits unsuspected at preoperative investigation. This has led to a change in surgical strategy in up to 20% of patients. In addition, by means of laparoscopic techniques, it is possible to mobilize the stomach and perform a safe transhiatal mediastinal dissection at least up to the level of the inferior pulmonary veins. PATIENTS AND METHODS: Laparoscopy-assisted esophagectomy was attempted in 43 patients over the past 3 years. The esophagectomy was performed via laparoscopy combined with right thoracotomy (group A) or with left cervicotomy and transmediastinal endodissection (group B). RESULTS: The overall conversion rate to laparotomy was 11.6%. No hospital deaths occurred. The morbidity rate was 20% in group A and 30.7% in group B. The mean hospital stay was 11 in group A and 10 days in group B. Five patients died between 11 and 19 months after surgery with recurrent disease. No port-site metastases were recorded during follow-up. CONCLUSIONS: This approach has proven feasible and safe in the medium-term follow-up. Further experience and a longer follow-up are needed to assess the impact of these procedures on long-term survival.