Clinicopathological profile and surgical challenges of gastric cancer in South-East Nigeria: A retrospective study

Abstract: BACKGROUND: Surgical challenges in advanced gastric cancer present a complex dilemma for surgeons in low-resource settings. The decision between attempting curative resection and opting for palliation is complicated by late disease presentation and limited diagnostic infrastructure. This study evaluates the clinicopathological profile, surgical management, and outcomes of gastric cancer patients to assess the utility of operative interventions in the face of poor prognostic indicators. MATERIALS AND METHODS: This retrospective observational study was conducted at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, analyzing 86 patients with histologically confirmed gastric cancer out of a total of 956 gastrointestinal malignancies. Data regarding patient demographics, risk factors, intraoperative findings, extent of surgical intervention, and postoperative outcomes were analyzed. RESULTS: The cohort was predominantly female (59.3%), with a peak age incidence between 61 and 70 years (61.6%). Dietary risk factors were prominent, with 91.9% of patients reporting consumption of smoked fish. Late presentation was the norm; 88.4% presented with unexplained weight loss and 73.3% with palpable abdominal masses. Intraoperative assessment revealed that 61.6% had advanced cancer and 40.7% had metastatic disease. Consequently, curative resection was achieved in only 50.0% of cases, while 31.4% of cases underwent palliative bypass and 18.6% were limited to exploratory laparotomy and biopsy. Postoperative complications occurred in 29.3% of patients, most commonly surgical site infections (14.0%). The prognosis was poor, with a confirmed mortality rate of 61.6% of cases and a high attrition rate, as 26.7% of patients were lost to follow-up. CONCLUSION: The management of gastric cancer in this setting is severely hampered by delayed diagnosis, resulting in a low resectability rate and high mortality. The high prevalence of palliative bypass and exploratory laparotomies, combined with limited survival duration, underscores the surgeon’s dilemma regarding the cost and trauma of surgery versus limited life expectancy. Future efforts must prioritize public health education on dietary risks – specifically smoked fish consumption – and early screening.