Aspects diagnostiques et thérapeutiques des cancers de l’estomac en milieu oncologique à Conakry

Abstract

L’objectif de ce travail etait d’analyser les resultats de la prise en charge diagnostique et therapeutique des cancers de l’estomac a l’unite de chirurgie oncologique de Donka. Il s’agissait d’une etude observationnelle, retrospective de type descriptif de 2007 a 2016. Le profil epidemiologique, les aspects anatomocliniques, le diagnostic, le bilan d’extension et les modalites therapeutiques ont ete decrits et analyses. Nous avons collige 41 patients avec un âge moyen de 53,8 ans. Le sexratio etait de 1,7. Les patients avaient consulte pour epigastralgie (85,4%), vomissements (75,6%) et anorexie (26,8%) avec un delai de consultation de 15,8 mois. Une masse epigastrique (61,0%), l’hepatomegalie (46,3%) et une ascite (31,7%) etaients presents. L’aspect endoscopique etait bourgeonnant (37,5%) et dans 50,0%, le siege etait antral. Ils’agissait d’adenocarcinome (18 cas), de carcinomes gastriques (9 cas), de dysplasie de haut grade (1 cas) et de tumeur stromale gastro-intestinale (GIST) (1 cas). Les metastases etaient presentes dans 27 cas (65,8%). Le traitement chirurgical a ete realise chez 20 patients (48,8%) avec un taux de resecabilite de 55 % (11 cas). La gastrectomie des 4⁄5 avec curage de type D2 a ete realisee dans 18 cas (72,2%).La mortalite operatoire etait de 2 cas(7,4%). Dix patients (24,4%) ont ete l’objet d’un traitement adjuvant dont 9 par chimiotherapie et 1 par radiotherapie.Les patients ont ete suivis avec un delai moyen de 43,8±8,6 mois [IC95% 27,0-60,0] au cours duquel 4 recidives (9,7%) et 32 deces (78%) ont ete enregistres. Le cancer de l’estomac est frequent et de diagnostic tardif dans notre contexte. Le traitement chirurgical des formes precoces et la chimiotherapie perioperatoire permettent d’ameliorer le pronostic de ces cancers. Mots cles : cancers, estomac, diagnostic, traitement, Conakry. The aim was to analyze the results of the diagnostic and therapeutic management of stomach cancers at the Donka Oncology Surgery Unit. This was a retrospective study of the descriptive type from 2007 to 2016. The epidemiological profile, the anatomoclinical aspects, the diagnosis, the extension assessment and the therapeutic modalities were described and analyzed. We collected 41 patients with a mean age of 53.8 years. The sex ratio was 1.7. Patients had consulted for epigastralgia (85.4%), vomiting (75.6%) and anorexia (26.8%) with a consultation time of 15.8 months. An epigastric mass(61.0%), hepatomegaly (46.3%) and ascites (31.7%) were present. The endoscopic aspect was budding (37.5%) and in 50.0%, the seat was antral. These included adenocarcinoma (18 cases), gastric carcinomas (9 cases), high grade dysplasia (1 case) and gastrointestinal stromal tumors (GIST) (1 case). Metastases were present in 27 cases(65.8%). Surgical treatment was performed in 20 patients with a resectability rate of 55% (11 cases). Gastrectomy of 4/5 with D2- type dissection was performed in 18 cases(72.2%) and the operative mortality was 2 cases (7.4%). Ten patients (24.4%) received adjuvant therapy, 9 with chemotherapy and 1 with radiotherapy. Patients were followed after a mean delay of 43.8 ± 8.6 months [95% CI 27.0-60 , 0] in which 4 recurrences (9.7%) and 32 deaths (78.04%) were recorded. Stomach cancer is common and of late diagnosisin our context. Surgical treatment of early forms and perioperative chemotherapy could improve the prognosis of these cancers. Keywords: stomach cancer, diagnosis, treatment, Conakry