Stomach Cancer: Surgical Management and Impact of Lymph Node Dissection in Survival at the Surgery “A” Department of the National Hospital of Point “G” (Mali)

Abstract

Introduction: Although its incidence has tended to decrease for several years, stomach cancer remains one of the most frequently diagnosed cancers worldwide. Globally, gastric cancer is the 4th most common cancer in men, the 5th in women, and the third leading cause of cancer death in men, the 5th in women. Patients and Methods: This was an analytical, prospective and descriptive study. Study Framework: Our study took place in the “A” surgery department of the Point “G” Hospital in Bamako. Study Period: August 1, 2003 to August 31, 2005. The design and preparation phase of the fact sheet lasted 1 month. The data collection phase lasted 18 months. All the patients who consulted for gastric tumor had a record. The follow-up phase of the patients lasted 6 months during which the patients were followed by appointment, by contact person or seen at home. Data entry and analysis were conducted with Epi-Info software (version 6.0). Inclusion Criteria: All patients hospitalized for gastric cancer in the “A” surgery department of the Point “G” Hospital. Result: The distribution of patients according to the evolutionary stage TNM was: Stage IV (50 cases, or 64.94%); Stage III (21 cases, or 27.27%); Stage II (6 cases, or 7.79%). In our series the average age was 59 with extremes of 20 to 85 years. The most represented age group was 46 - 65 years. Men were 60 cases (77.90%) 17 cases for women (22.10%). The sex ratio was 3.53 in favor of men. All 77 patients were recruited during the outpatient clinic, including 55 patients referred by a physician and 20 patients who came by themselves. Esogastroduodenal fibroscopy was performed in all of our patients. The tumor was localized: to the cardia in 10 cases; cardiac fundus in 2 cases; antrum in 24 cases; antro-pyloric in 28 cases; Pylorus in 1 case; great curvature in 5 cases; small curvature in 2 cases. Postoperative complications were: parietal infection in 12 cases or 17.40%; digestive fistula in 3 cases and evisceration is 1.40%. The overall three-month survival rate was 51.90% and at 6 months was 48.10%. Conclusion: Stomach cancer is the most common digestive cancer in Mali. In Africa the diagnosis is usually late and the R1 lymph node dissections remain the basic technique, despite the results obtained in the Japanese series. The results of several major series argue for their effectiveness in improving patient survival.