ORIGINAL SCIENTIFIC REPORT
Operations for Suspected Neoplasms in a Resource-Limited
Setting: Experience and Challenges in the Eastern Democratic
Luc Malemo Kalisya
Jacques Fadhili Bake
David H. Rothstein
Sarah B. Cairo
Published online: 31 December 2017
Internationale de Chirurgie 2017
Introduction Surgery is an essential component of a functional health system, with surgical conditions accounting for
nearly 11–15% of world disability. While communicable diseases continue to burden low- and low–middle-income
countries, non-communicable diseases, such as cancer, are an important cause of morbidity and mortality worldwide.
Preliminary data on malignancies in low- and middle-income countries, speciﬁcally in Africa, suggest a higher
mortality compared to other regions of the world, a difference partially explained by limited availability of screening
and early detection systems as well as poorer access to treatment.
Objective To evaluate the diagnosed tumor burden in the Eastern Democratic Republic of Congo (DRC) and review
literature on existing and suspected barriers to accessing appropriate oncologic care.
Methods This is a retrospective study carried out at Healthcare, Education, community Action, and Leadership
development Africa, a 197-bed tertiary referral hospital, in the Province of North Kivu, along the eastern border of
the DRC from 2012 to 2015. Patient charts were reviewed for diagnoses of presumed malignancy with biopsy results.
Results A total of 252 cases of suspected cancer were reviewed during the study period; 39.7% were men. The
average age of patients was 43 years. Amongst adult patients, the most common presenting condition involved breast
lesions with 5.8% diagnosis of ﬁbrocystic breast changes and 2.9% invasive ductal carcinoma of the breast. 37.3% of
female patients had lesions involving the cervix or uterus. The most common diagnosis amongst male adults was
prostate disease (16.7% of men). For pediatric patients, the most common diagnoses involved bone and/or cartilage
(27.3%) followed by skin and soft tissue lesions (20.0%). All patients underwent surgical resection of lesions; some
patients were advised to travel out of country for chemotherapy and radiation for which follow-up data are
Conclusion Adequate and timely treatment of malignancy in the DRC faces a multitude of challenges. Access to
surgical services for diagnosis and management as well as chemotherapeutic agents is prohibitively limited.
Increased collaboration with local clinicians and remote specialist consultants is needed to deliver subspecialty care
in resource-poor settings.
Poster presentation at American College of Surgeons, San Diego
& Sarah B. Cairo
COSECSA Training Program, HEAL Africa Hospital, Goma,
North Kivu, Democratic Republic of Congo
Medicines San Frontiers, Geneva, Switzerland
Department of Pediatric Surgery, John R Oishei Children’s
Hospital, 1001 Main Street, Buffalo, NY 14202, USA
Department of Surgery, State University of New York at
Buffalo, Buffalo, NY, USA
World J Surg (2018) 42:1913–1918