Gastric Cancer in Southern Benin: Access to Surgical Treatment and Postoperative Outcomes

Abstract

Background: Gastric cancer remains a major public health challenge in low- and middle-income countries, where late-stage diagnosis and limited access to specialized surgical oncology care adversely affect outcomes. Surgery remains the cornerstone of curative treatment; however, data on access to surgical management and survival in West Africa are scarce. This study aimed to assess access to surgical treatment and survival outcomes among patients with gastric cancer managed in referral hospitals in southern Benin. Meth ods: We conducted a retrospective descriptive study over a nine-year period (January 1, 2013 to December 31, 2021) in three tertiary hospitals in the Littoral Department of Benin. All patients who underwent surgery for histologically confirmed gastric cancer were included. Sociodemographic characteristics, diagnostic work-up, tumor stage (UICC TNM 2016), surgical procedures, and outcomes were analyzed. Overall survival was estimated using the Kaplan-Meier method. Results: Among 114 identified cases of gastric cancer, 52 patients (45.6%) underwent surgical intervention. The mean age was 57.2 ± 12.3 years, with a male predominance (61.5%). Upper gastrointestinal endoscopy was performed in 92.3% of cases, while staging computed tomography was available in 55.8%. Tumors were predominantly distal, involving the antrum or antropyloric region in 86.5% of patients. Adenocarcinoma was the most frequent histological type (97.4%). Most tumors were diagnosed at an advanced stage (T4: 71.2%; stage III: 57.7%). Partial gastrectomy was the most commonly performed procedure (57.7%), whereas palliative procedures accounted for a substantial proportion of cases. Surgical management was compliant with international oncologic recommendations in 65.4% of patients. Among the 18 patients with available follow-up data, the median overall survival was 6 months. Conclusion: In southern Benin, gastric cancer is frequently diagnosed at an advanced stage, resulting in low resectability rates and poor survival outcomes. Surgery remains the central component of treatment but is often limited to palliative intent due to delayed presentation. Improving early diagnosis, accurate staging, and access to standardized surgical oncology care is essential to increase curative resection rates and improve survival in this setting.