CRC surgery trends in Kenya, 1993-2005.
BACKGROUND
CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce.


OBJECTIVE
The aim of this study was to evaluate the presentation, treatment, and outcome pattern of CRC and to compare the care processes for two time periods.


METHODS
The setting was Kenyatta National Hospital (KNH), a teaching and referral center.


METHODS
A total of 259 patients seen over two time periods (1993-1998 and 1999-2005) were analyzed for admission date, sex, subsite involvement, diagnostic process, treatment, follow-up, and outcome. The distribution of variables between the time periods were analyzed using Student's t-test and chi2 as appropriate. Survival trends were generated using Kaplan Meier method; p<0.05 was statistically significant.


RESULTS
The average number of CRC diagnoses showed a 2.7-fold increase during the study periods. The mean age at presentation was 49.7 years. The mean duration of symptoms was 29.6 weeks; and the commonest subsite was the rectum (55.3%). The overall resection rate was 67.7%. For rectal tumors the abdominoperineal rate was 51.4%. Mortality was higher for poorly differentiated cancer, advanced disease, age>50 years, and emergency surgery. There was no change in the age, duration of symptoms, proportion of patients<40 years, or the colon/rectal ratios of the cancer site. The second time period saw more adjuncts for diagnosis, less in-hospital mortality, and better staging data.


CONCLUSIONS
CRC peaks during the fifth decade of life in Kenyans. The disease is characterized by late presentation, rectal preponderance, and inadequate pathology data. Improved patient follow-up will unravel the true pattern of disease outcome.
Department of Human Anatomy, University of Nairobi, PO Box 30197, 00100, Nairobi, Kenya. hsaid2ke@yahoo.com
Hassan
H
Saidi
Elly O
EO
Nyaim
Joseph W
JW
Githaiga
David
D
Karuri
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome