CRC surgery trends in Kenya, 1993-2005
Hassan Saidi1, Elly O Nyaim, Joseph W Githaiga
1Department of Human Anatomy, University of Nairobi, PO Box 30197, 00100, Nairobi, Kenya. hsaid2ke@yahoo.com
Background:
CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce.
Objective:
The aim of this study was to evaluate the presentation, treatment, and outcome pattern of CRC and to compare the care processes for two time periods.
Setting:
The setting was Kenyatta National Hospital (KNH), a teaching and referral center.
Patients And Methods:
A total of 259 patients seen over two time periods (1993-1998 and 1999-2005) were analyzed for admission date, sex, subsite involvement, diagnostic process, treatment, follow-up, and outcome. The distribution of variables between the time periods were analyzed using Student's t-test and chi2 as appropriate. Survival trends were generated using Kaplan Meier method; p<0.05 was statistically significant.
Results:
The average number of CRC diagnoses showed a 2.7-fold increase during the study periods. The mean age at presentation was 49.7 years. The mean duration of symptoms was 29.6 weeks; and the commonest subsite was the rectum (55.3%). The overall resection rate was 67.7%. For rectal tumors the abdominoperineal rate was 51.4%. Mortality was higher for poorly differentiated cancer, advanced disease, age>50 years, and emergency surgery. There was no change in the age, duration of symptoms, proportion of patients<40 years, or the colon/rectal ratios of the cancer site. The second time period saw more adjuncts for diagnosis, less in-hospital mortality, and better staging data.
Conclusion:
CRC peaks during the fifth decade of life in Kenyans. The disease is characterized by late presentation, rectal preponderance, and inadequate pathology data. Improved patient follow-up will unravel the true pattern of disease outcome.
