Surgical Resection for Colorectal Cancer Improves Survival in Uganda

Abstract

Introduction: In Uganda and other developing low-income countries in Sub-Saharan Africa, colorectal carcinoma (CRC) incidence and mortality rates are increasing whereas in high income developed countries, CRC rates are declining. Many patients do not have access to curative surgery and oncological treatment for CRC in Uganda. In this study, we compared the survival outcomes of patients who underwent curative surgery, and, if necessary, adjuvant chemotherapy to those who did not to assess the impact of surgery and oncology care on CRC in the resource-limited setting of a low-income developing country. Methods: Participants with a diagnosis of CRC between 1 January 2008 and 31 December 2018 were included. These patients had linked data in the Kampala Cancer Registry and medical records from hospitals in Uganda. Data on whether the patients had or did not have curative surgery and adjuvant chemotherapy were obtained. Our outcome variable was survival at 3 years. We computed and compared survival using the log-rank test. Results: Two hundred and forty seven patients were included in the study cohort. These were 177 (71.66%) patients that had curative surgery, while 70 (28.34%) had no curative surgery. Curative rectal cancer surgery had a better survival than no curative surgery (p=0.003). Curative colon cancer surgery tended to have a better survival than no surgery (p=0.137). Curative surgery and adjuvant chemotherapy showed better survival than no surgery with no adjuvant chemotherapy (p=0.007). Conclusions: In a resource-limited environment, curative surgery and if necessary, combined with adjuvant chemotherapy improves survival. The findings in our study therefore serve to encourage the expansion of CRC care by improving the surgery and oncology infrastructure in resource-limited environments due to the increasing burden of CRC.