Issues in the surgical management of skin squamous cell cancers in albinos-experience of two surgical oncology units in Burkina Faso.

BACKGROUND AND OBJECTIVES: Skin cancers in albinos are frequent in sunny countries. The surgeon plays a crucial role in their treatment. The objective was to describe the challenges of surgical management of skin cancer in albinos. METHODS: Retrospective, descriptive, and multicenter study on skin cancer surgery in albinos performed over the past 14 years in Ouagadougou. We were interested in surgery indications, techniques, and results. Survival was assessed using the Kaplan-Meier method. Comparisons of proportions were made by Student's t-test. RESULTS: The cancers were multiple synchronous in 41.3%. We identified 46 albinos with 71 skin cancers. Surgery was performed in 93%. Lesions were located on the back, upper limbs, and head and face in 40.9%, 30.3%, and 16.7%, respectively. Precancerous lesions were treated concomitantly in 23.6%. The surgery consisted of a lumpectomy. Direct suturing and mobilization of flaps allowed skin coverage in 17.9% and 34.3%, respectively. Lymph node dissection was associated with the limbs in 73.1% of localizations. The average number of lymph nodes removed was 11, with extremes of 7 and 14. Node invasion was noted in 16 out of 19 cases. The resection margins were invaded in 7.5% and required surgical revision. Recurrences were noted in 8.9% of cases. Overall 2-year survival rate was 55.8%. CONCLUSIONS: Surgery must meet the triple challenge of treating single or multiple synchronous cancers, precancerous lesions, and allowing good healing. Early diagnosis would reduce the rate of secondary healing and improve survival. The absence of extemporaneous histology and the large size of the tumors associated with the delay in diagnosis meant that surgery, whenever possible, was limited to wide and deep resection, to ensure healthy margins.

The outcomes of palliative surgical treatment in a context of rising incidence of gastro intestinal cancers in Burkina Faso, Africa.

BACKGROUND AND OBJECTIVES: Digestive cancers are frequent and of late diagnosis in Africa. Palliative surgery therefore plays an important role. Our objective is to describe its indications, techniques and results in primary digestive cancers. METHODS: Retrospective, bicentric, descriptive study of palliative surgery for primary digestive cancer, performed in Ouagadougou over the last twelve years. The results were assessed according to the degree of improvement in the patients' quality of life. We divided the patients into four groups according to the improvement of the quality of life after the operation. The results were considered very satisfactory when the symptoms disappeared completely. They were considered satisfactory when the symptoms decreased in intensity. They were unsatisfactory when the symptoms kept the same intensity. They were considered poor when the symptoms persisted with greater intensity. RESULTS: Six hundred and thirty-nine palliative digestive cancer surgeries were performed. All patients had clinical symptoms deteriorating their quality of life (56.7%) or even a surgical emergency (43.3%). Biliodigestive diversion, gastroentero-anastomosis and colostomy were the palliative procedures performed respectively in 26.6%, 16.9%, and 34.1%. Complications were noted in 11.7%. These were digestive fistulas in 9 cases, retraction and stomal prolapse in 11 cases. The improvement of the quality of life was very satisfactory in 76%. CONCLUSIONS: Palliative surgery is widely practiced in digestive cancers. It improves the quality of life. African surgeons should be aware and well-educated to safely perform surgical palliative procedures.

Place de la chirurgie dans la prise en charge des cancers du sein chez la femme au Centre Hospitalier Universitaire Yalgado Ouedraogo: a propos de 81 cas

Etudier la place de la chirurgie dans la prise en charge des cancers du sein au centre hospitalier universitaire Yalgado Ouedraogo. Nous avons realise une etude prospective et descriptive sur dix (10) mois portant sur la place de la chirurgie dans le cancer du sein. Elle a eu pour cadre les services de gynecologie-obstetrique et de chirurgie viscerale et digestive du centre hospitalier universitaire Yalgado Ouedraogo. Ont ete pris en compte les indications; les gestes et les resultats de la chirurgie. Nous avons collige 81 cancers mammaires. Le delai moyen de consultation a ete de 14;26 mois. Les tumeurs T3 a T4 representaient 82;71% des cas. Trente-huit patientes (46;91%) ont ete operees. La chimiotherapie neo adjuvante a ete realisee dans 29;63% des cas. Trente-quatre patientes (41;97%) etaient operables d'emblee. Il s'agissait de mastectomie selon Madden dans 94;74% des cas et de chirurgie de proprete dans 2 cas (5;26% des cas). Une chimiotherapie adjuvante a ete realisee chez 52;63% des patientes operees. Des complications a type de lymphocele ont ete notees dans 23;68% des cas. Leur traitement a consiste en des ponctions evacuatrices. Les indications de la chirurgie sont limitees par le retard diagnostique corollaire de stades avances des cancers du sein. L'absence de la radiotherapie rend delicate la pratique de la chirurgie conservatrice et la mastectomie occupe toujours une place importante. Un diagnostic precoce permettrait d'augmenter les indications chirurgicales