Cancer Surgery in Low-Income Countries An Unmet Need

Objectives: To describe the surgical oncology experience at a major regional hospital in Malawi and to identify barriers to improved outcomes. Design: Retrospective review of operating logbooks from a single tertiary referral center. Setting: Major tertiary referral center (Kamuzu Central Hospital) in Lilongwe, Malawi, in sub-Saharan Africa. Patients: Patients were identified with a suspected diagnosis of cancer from January 1, 2004, through March 7, 2007. Main Outcome Measures: Cancer cases were classified according to patient demographic characteristics, disease location, and therapeutic intent. The Malawi data were compared with US data from the Surveillance Epidemiology and End Results database. Results: A malignant diagnosis was suspected in 255 of the 1440 patients undergoing a major resection (17.8%) (mean patient age, 53 years). The most common cancers in males were prostate, esophageal, and gastric. In females, the most common cancers were breast, colon, and esophageal. Many of the procedures were performed with palliative intent. Conclusions: Cancer surgery comprises a significant proportion of the surgical caseload in low-income countries. Patients often present with late-stage, inoperable cancer. The participation of the surgical community is critical for addressing barriers to effective cancer care. Arch Surg. 2012; 147(12): 1135-1140