ArticleWorld journal of surgery2020
Curative Surgery Improves Survival for Colorectal Cancer in Rural Kenya.
Article in World journal of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 23 citations in OpenAlex.
- Observational
- The descriptive epidemiology of age at colorectal cancer diagnosis in Africa: a systematic review and meta-analysis.EClinicalMedicine · 2025Article
- Review
- The prognostic ability of radiotherapy of different colorectal cancer histological subtypes and tumor sites.Scientific reports · 2023Article
- CT without borders: Comparison of diagnoses for abdominal pain from a teaching hospital in rural Kenya and a US academic medical center.Abdominal radiology (New York) · 2023Article
- Colorectal Surgery Practice, Training, and Research in Low-Resource Settings.Clinics in colon and rectal surgery · 2022Review
- Colon and Rectal Cancer Management in Low-Resource Settings.Clinics in colon and rectal surgery · 2022Review
- Review
- Prognostic Factors for Survival of Colorectal Adenocarcinoma Patients in Uganda.Cancer management and research · 2022Article
- Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND/
aimsColorectal cancer (CRC) is increasing in low- and middle-income countries. Surgical care is essential for the treatment. Many patients do not have access to curative surgery for colorectal cancer in rural Kenya. To better understand the impact of surgical care on colorectal cancer in a resource-limited setting, we compared the experience of patients undergoing operations to those who did not.
methodsAll patients with histologically confirmed CRC at Tenwek Hospital from January 1, 1999, to December 31, 2017, were reviewed. Demographic and clinical data were extracted from records when available. The exposure was either curative operation, palliative operation, or no operation. The primary outcome was survival at 5 years, assessed with Cox proportional hazard analysis after propensity-score matching for age, sex, tumor site, time period, and stage.
resultsOne hundred and sixty-five patients were identified on chart review. Survival information was available for 150 patients with a median follow-up of 319 days. Fifty-two percent had colon cancer and 48% had rectal cancer. At diagnosis, the mean age was 55.4 years (SD: 16.7) and the male to female ratio was 1.1:1. Thirty-nine percent underwent curative operations, 25% palliative operations, and 36% no operations. One-year survival was estimated to be 98% for curative surgery, 73% for palliative surgery, and 83% for no surgery (p = 0.0005). On crude analysis, 5-year survival improved with curative operation in comparison to no operation with a hazard ratio of 0.30 (CI: 0.14-0.64) (p = 0.002). After propensity matching, the hazard ratio for curative operation versus no operation remained significant, 0.34 (CI: 0.14-0.80) (p = 0.01).
conclusionsCurative surgery improves survival in our resource-limited environment. Although various factors contribute to the use of surgical treatment, the survival advantage persists after adjusted analysis. Barriers exist for access to prompt surgical evaluation and treatment. Surgical care should be a priority to address the increasing burden of CRC in resource-limited settings.
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