Surgical oncology at a major referral center in Ghana: Burden, staging, and outcomes

Background and ObjectivesOutcome data after surgery for cancer in Sub-Saharan Africa are insufficient. We aimed to describe the presentation and outcomes of patients with solid cancers managed at a tertiary hospital in Ghana. MethodsRecords of cancer patients admitted to Komfo Anokye Teaching Hospital general surgery wards from 2013 to 2016 were reviewed for data on presentation, staging, management, and mortality. Patients discharged alive were followed-up by biannual telephone calls to establish their postdischarge status. Survival analysis was performed for patients with pathologic or radiologic confirmation of cancer and adequate staging. ResultsA total of 343 patients were included. Of these, 76% were female. The most common diagnoses were breast 136 (40%), foregut 70 (20%), and colorectal 63 (18%) cancers. Cancer diagnosis was confirmed by pathology or radiology in 281 (82%) patients, but only 112 (40%) had adequate staging. Seventy-four (66%) patients were stage IV. Two-year overall survival for all 343 patients was 22% to 69%, depending on cancer site. Among those with adequate staging who were alive after postoperative 90 days, 3-year survival was similar for curative compared with palliative operations (P=0.64). ConclusionsImproved capacity for both therapeutic and palliative cancer care is needed to achieve better outcomes by more appropriate allocation of surgery with respect to the goal of treatment.