The surgical implications of advanced cancers in low- and middle-income countries: Challenges, opportunities, and...

Surgical intervention remains a cornerstone of cancer management. In low- and middle-income countries (LMICs), however, the high burden of advanced-stage cancers presents distinct clinical, logistical, and ethical challenges for surgeons working in resource-constrained environments. This review aims to examine how advanced-stage cancer impacts surgical oncology practice in LMICs, and to identify practical, context-specific strategies that surgeons can adopt to navigate these challenges, optimize patient outcomes, and strengthen cancer surgery delivery in resource-limited settings.

This narrative review draws on peer-reviewed literature published between 2000 and 2025, identified through purposive searches in PubMed, Scopus, and Google Scholar. Keywords included "advanced cancer," "surgery," "low- and middle-income countries," and "oncology workforce." Articles were selected based on relevance to the surgical management of advanced cancers in LMICs, with a focus on real-world clinical challenges, system-level barriers, and potential solutions.

Surgeons in LMICs contend with advanced-stage presentations, limited diagnostic and treatment infrastructure, inadequate subspecialty training, and constrained perioperative support. These factors often restrict curative options and complicate surgical decision-making and outcomes. Nonetheless, opportunities exist for surgeons, including contributing to early detection, advocating for timely referrals, and spearheading local clinical protocols. Surgeons can also lead in capacity building, multidisciplinary collaboration, and context-specific research to inform policy and practice.

While the management of advanced-stage cancer in LMICs presents complex challenges, surgeons have a vital role in bridging gaps in care.