Nigerian Journal of Surgery

: 2019  |  Volume : 25  |  Issue : 2  |  Page : 233--240

Abstracts of papers presented at the joint surgical oncology congress of the association of surgeons of Nigeria and the Nigerian chapter of the American College of surgeons held in partnership with senologic international society


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. Abstracts of papers presented at the joint surgical oncology congress of the association of surgeons of Nigeria and the Nigerian chapter of the American College of surgeons held in partnership with senologic international society.Niger J Surg 2019;25:233-240

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. Abstracts of papers presented at the joint surgical oncology congress of the association of surgeons of Nigeria and the Nigerian chapter of the American College of surgeons held in partnership with senologic international society. Niger J Surg [serial online] 2019 [cited 2020 Jul 5 ];25:233-240
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 Current Management of the Axilla in the Patient With Breast Cancer

Öztürk A

Department of Surgery, Biruni University Hospital, Istanbul, Turkey

The presence of nodal metastasis is a key prognostic predictor in breast cancer with significant impacts on treatment planning. The nodal status often determines the need for systemic therapy, the extent of surgery, reconstruction options, and the need for radiation after mastectomy. The introduction of SLND for axillary staging in breast cancer was one of the most important contemporary advances in care, allowing for accurate staging while minimizing morbidity. When a sentinel lymph node biopsy shows no cancer cells in the lymph node, the standard method is to omit axillary dissection. Complications of axillary lymph node dissection may include upper arm edema, glenohumeral joint excursion obstacles, and neuropathy. Several procedures are available for staging and treating the axilla. A tailored surgical approach, with careful assessment of risk-benefit and patient preference, is guiding the evolving modern management of the axilla for women with breast cancer.

 Basic Systemic and Endocrine Therapy for Low Middle Income Countries

Ordu C

Department of Medical Oncology, Florence Nightingale Hospital, Istanbul, Turkey

More than half of the global cancer burden is found in low middle-income countries (LMIC). Cancer survival is worse in (LMIC) compared to developed countries. This has resulted in 5-year survival rates of approximately 80%, 60% and 40% for high, middle and LMIC, respectively. It is estimated that by 2035, two-thirds of all new cancer will occur in LMIC. The five-year survival rate for patients with breast cancer is 84% in the USA whereas in The Gambia, is just 12%. Developments in medical management strategies have resulted in notable declines in cancer mortality rates in high-income countries(3). Besides, most patients in sub-Saharan Africa present with advanced stage disease: stage III and IV. It is largely known that systemic treatment represents one of the great challenges in cancer control efforts in LMIC. Access barriers to systemic therapy are real especially due to lack of expertise in pathology and expertise in medical oncology (5). Basic systemic therapy does not always require expensive treatments to achieve improvement in cancer survival, however, it remains largely unavailable in many LMIC settings. Slightly fewer than 10% of the countries had a HER2-targeted therapy as essential medicine. Unlike HER2-targeted therapies (<10%), aromatase inhibitors (12%) and taxanes (28%); tamoxifen and first generation chemotherapeutic regimens (e. g., anthracycline-based regimens) were frequently found in the national essential medical list (NEMLs) (71-78%). Eastern Mediterranean and African regions less frequently incorporated all components of breast cancer treatment in their NEMLs. Taxanes as well as aromatase inhibitors and luteinizing hormone-releasing hormone (LHRH) agonists may be used as adjuvant therapy. Use of trastuzumab for HER2-neu-positive disease becomes feasible. At the maximal level, dose-dense chemotherapy can be implemented. Locally advanced breast cancer (LABC) is represented by stages IIIA, IIIB, and IIIC. In LMIC, LABC is considered to be the commonest form of presentation as well. Combined modality therapy utilizing neoadjuvant chemotherapy (anthracycline-based chemotherapy) followed by locoregional therapy (surgery, radiation, or both) is emerging globally as the standard of care for LABC including inflammatory breast cancer. Inclusion of taxanes, aromatase inhibitors, as well as trastuzumab (for HER2-positive disease) becomes implemented at these levels as well. There are level 1 evidence for systemic therapy (endocrine therapy, chemotherapy, or molecularly targeted therapies), most of which are not present in LMIC in patients with metastatic breast cancer unlikely to be cured of their disease by any means. Sequential combination chemotherapy, use of trastuzumab, lapatinib, and bisphosphonates become available at the enhanced level.

 National Breast Cancer Screening Program in Turkey-2019

Varol G

Department of Public Health, Medical Faculty, Tekirdağ Namık Kemal University, Tekirdağ, Turkey

Introduction and Aim: Breast cancer is one of the most frequent cancers around the world, and the most common cancer in women with a high mortality. The incidence and mortality from breast cancer are increasing worldwide and particularly rapidly across the countries with limited resources. Breast cancer incidence in developed countries is higher, while relative mortality is greatest in less developed countries like Turkey. Screening for breast cancer, is part of the armamentarium of public health and contributes to lowering mortality and improving survival rates for these diseases. Mammography has been the preferred screening modality. Multiple screening trials in the past have shown that population-based breast cancer screening reduces mortality from breast cancer in the screened population. The aim of this presentation, is to explain the characteristics and functioning of National Breast Cancer Screening Program in Turkey. National Breast Cancer Screening Program in Turkey: Is this Program Necessary? Breast cancer is the most common cancer type in women and the first in mortality. Incidence of breast cancer increases in relation with age, furthermore, since the incidence increases in many western European countries, mortality ratios stay stable or in trend of declining. Breast cancer incidence which is high in developed countries is dramatically increasing in developing countries like Turkey. In the report of WHO in 2008, it is stated that the breast cancer is the most common cancer type in women in Turkey with the rate of 24%. The Cancer Control Department of Health Ministry of Turkey in 2016 Report says that breast cancer incidence is 46.8 per 100,000 and each year approximately 17,000 women are diagnosed breast cancer. Stage at the diagnosis is an important factor to determine the method of treatment as well as breast cancer mortality and healing ratios. Breast cancer causes serious concern even in healthy women, for both reasons of incidence and mortality. The steps that should be taken in order to decrease this threat can be sorted as following: self-presenting the risk of breast cancer in each society, determination of the risk groups, informing the individuals with risk, extending the screening and reachable treatment programs. There isn't any method that proved its affect in preventing the breast cancer yet, the most important chance is the early diagnosis. The breast self-examination (BSE), mammography and breast clinical examination (BCE) are accepted as the most important screening methods in early diagnosis of breast cancer. Breast cancer is a progressive disease, life expectancy is high in case of early diagnosis. In countries where early diagnosis and treatment are developed, for the patients diagnosed with breast cancer, the percentage of 5 years of survival is about 90-95%. With the help of screening activities for breast cancer, 63.7% of breast cancers can be diagnosed at early stages. For the patients diagnosed in early stage, 5 years of life expectancy is 97.9%. Breast cancer mortality declines in industrialized countries where standard mammography screenings are applied. Some think this situation is the result of developments in treatment while others believe that early diagnosis facilitates the treatment options. Despite the ongoing mammography screening activities, most of the breast cancers in our country are diagnosed at late stages. An effective screening should involve at least 70% of the population and this is possible with population-based screening programs. National Population-based Screening: How it Works? Cancer screenings are executed by Cancer Early Diagnosis, Screening and Training Centers (KETEM) in Turkey. It's executed screening programs related with breast, cervical and colorectal cancers. In these centers, there are health personnel from different branches such as doctors, nurses and technicians who have the necessary training in cancer prevention and screening work. Employees are also trained on communication and health education. Women are invited by letter or phone for screenings of especially breast and cervical cancers including relevant examinations and tests. All these screening services are completely free of charge. In Turkey, the national population-based breast cancer screening guideline was published by the Cancer Control Department of Health Ministry in 2004 recommending biannual mammographic screening for women aged 50-69 years similar to European Union countries However, there are differences in age distribution and health expenditure between Turkey and western countries. The population is younger in Turkey than other western countries, and 68% of women are less than 40 years old. The statistical analysis of Turkish breast cancer registry program also showed that almost 50% of women with breast cancer were premenopausal and less than 50 years old. Therefore, the feasibility of an organized mammographic screening program including women aged between especially 40-50 years should be studied in Turkey. National Turkish Guide suggests the start of screening at the age of 40 and ends at the age of 69 and applied once in two years. Targeted population for screening is about 12 million people. Community based screenings are executed by KETEM. For the training of the personnel of these centers, collaboration established with profession chambers such as Turkish Medical Association, Breast Associations Chambers, Turkish Radiology Association. The Ministry expects the early phase breast cancer diagnosis ratio to reach over 50% with the screening program as soon as possible. There is also opportunity screening are applied to women who apply to hospitals. In addition, primary health care physicians' direct women for screening. Suspected cases send to reference hospitals for post-screening diagnosis and treatment. Thus, the patients will have the chance of diagnosis and treatment in their regions in post screening period. Main Problems and Solutions: Despite awareness and training activities, there are also problems in screening program. Some of them are in relation with low screening ratios, inadequate numbers of experts, problems related with access to service and lack of awareness. These are considered as main causes. In order to solve majority of these problems, first of all, primary health care physicians should be integrated into screening program. All primary health care physicians should be given health education about importance of early diagnosis, how to perform BSE, and they should regularly monitor and refer to the targeted population for the CBE and mammography. Integration of primary health care physicians to screening program has positive effects on increasing awareness and success of the screening program. In additional, it is important for screening to provide sufficient resources for the KETEM and to contribute to both quantitative and qualitative developments. In conclusion, despite some problems the national breast cancer screening program in Turkey continues to be successful. Scientific evidence is needed, and national or international quality academic studies should be supported.

 Breast Cancer Screening in Turkey: Population-based Mammography Screening in Bahçeşehir, A District of Istanbul

Akyurt N

Department of Medical Imaging, Vocational School of Health Services, Marmara University, Istanbul, Turkey

Background and Objectives: Bahçeşehir Breast Cancer Screening Project is a 10 year-organized population-based screening program (2008-2018) carried out in women aged between 40-69 years. Since Bahçeşehir is one of the youngest residential areas on the European side of Istanbul, this district was chosen to carry out the project. The address-based population registration system is well organized in this county, and the population has a high level of education with a higher income compared to other regions of Turkey. Materials and Methods: Screening mammographies were performed in women aged between 40-69 years who accepted the screening invitation. Screening was performed in 6912 women who registered at the Bahçeşehir Breast Cancer Screening Center between January 2009 and October 2018 every two years in 3 sequential rounds. A total of 14485 bilateral mammographies were performed during the Project (29737 mammographies and 4298 ultrasound scannings). Bilateral mammograms were obtained in 2 different projections. All examinations were doubly read by two independent radiologists with an experience of 8 years who were blinded to each other's interpretations. Both radiologists made their decisions in consensus for further evaluation. Women with mammograms categorized as suspicious were recalled for additional workups. If needed, histopathologic confirmation was made by various biopsy methods. Results: The number of screen-detected cancers in total was n = 70 (4.8/1000) (consistent with other screening programs). The number of screen-detected cancers in women aged between 40-49 years was n = 32 (45,7%) and in women aged between 50-69 years was n = 38 (54,3%). For a high-quality breast cancer screening program, a high cancer detection rate along with an earlier stage and also a low recall rate is required. The recommended recall rates are less than 10%, 5% and 7% in United States, European guidelines and United Kingdom guidelines, respectively. Limitations: This study is the first organized screening program held in Turkey. The radiologists generally practice in diagnostic breast imaging units whereas screening is solely opportunistic. Therefore, they are not used to evaluate a high number of screening mammograms. Women aged between 40-49 years have dense mammograms leading to difficulty in interpretation. The new malpractice law on medical practices in Turkey brought more responsibilities and penalties to the doctors that could cause an insecurity feeling in decision making. Conclusion: A high incidence of early cancer has been reached in this study, leading to reduced mortality rate, more conservative therapy and more gentle therapeutic approach, yielding the efficacy of an organized population based mammographic screening in a developing country.


Many thanks to Prof. Dr. Vahit ÖZMEN, Founding and Honorary President of Bahçeşehir Breast Cancer Early Diagnosis and Screening Project, which he launched in 2008.

 Comparison of Biochemical Efficacy of Orchidectomy and Medical Castration (Lhrh Analogue, Zoladex®) in Patients with Advanced Prostate Cancer at Lagos State University Teaching Hospital, Lagos

Omorinde MO, Jeje EA, Ikuerowo SO, Omisanjo OA

Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos

Background and Objectives: The study compared the biochemical efficacy of medical castration (Zoladex®) with bilateral total orchidectomy in reducing serum testosterone and serum Prostate Specific Antigen (PSA) in patients with advanced Prostate cancer (PCa). Materials and Methods: A prospective, hospital based, non-randomized clinical study was conducted over one year period from November 2016-October 2017 and each patient was followed up for six months. Patients that met the inclusion criteria were recruited consecutively into two groups; surgical and medical castration groups. Serum testosterone and PSA were measured before prostate biopsy was done using chemiluminescent immunoassay. Both groups of patients were started on Tablet Bicalutamide 50 mg daily for two weeks starting from the day treatment was commenced. Serum testosterone and PSA were repeated at 1, 3-and 6-months following commencement of treatment in the two groups. Pro forma designed for the study was used to gather patients' biodata records, test results and complications. The data were analyzed using the Statistical Package for Social Sciences (SPSS IBM) version 20.0. Results: A total of fifty patients were studied, twenty-five patients in each group. The percentage drop in median serum testosterone at 1,3 and 6 months for the orchidectomy group was 85.40%, 91.30%, 91.90% respectively while the percentage drop in median serum testosterone for the medical castration group at 1,3 and 6 months was 87.30%, 93.80%, 94.00% respectively. The percentage drop in median serum PSA at 1,3 and 6 months for orchidectomy treatment group was 69.40%, 97.50% and 99.20% respectively while for medical castration group, the percentage drop in median serum PSA at 1,3 and 6 months was 68.40%, 96.80%, 98.20% respectively. Local complications associated with orchidectomy were scrotal hematoma (20%) and surgical site infection (28%). Injection site reaction (8%) was recorded in medical castration group. All patients in both groups had hot flushes, reduced libido and weak erection as systemic complications. Conclusion: Androgen Deprivation Therapy (ADT) still remains the mainstay of management of advanced PCa. Medical castration (Zoladex®) and surgical castration(Orchidectomy) are both efficacious in the short term treatment of advanced PCa.

 Ultrasound-Guided Core Biopsy of Breast Lesions in a Resource Limited Setting: Initial Experience of a Multidisciplinary Team

Okoli CC, Ebubedike UR, Ihekwoaba EC, Egwuonwu OA, Umeh EO, Ukah CO, Emegoakor C, Onwukamuche ME, ANyanwu SNC, Chianakwana GU, Onyiorah IV, Anyiam DC

Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Background and Objectives: There is increasing tendency to multidisciplinary care of patients with of breast lesions. This study sought to evaluate the initial experience of the diagnostic arm of a new breast program in a resource limited setting. Materials and Methods: In 2015, we commenced the pilot phase of an IRB-approved breast care protocol. As part of the protocol's diagnostic arm, an ultrasound-guided breast core biopsy training was implemented. Eligible patients were clinically evaluated and underwent CNB using 16G needle under US guidance. The procedure was rated by the participants and histopathological results compared with surgical specimens. Results: Eighty-six participants (18.22%) with 113 palpable breast lesions completed the study. The diagnostic accuracy, sensitivity, and specificity were 94.44%, 92.86%, and 95.83% respectively. Unweighted kappa-coefficient (k) agreement between histopathology of core biopsy and surgically excised specimens, were 0.798(95% CI of 0.69-0.90) and 0.801(95% CI of 0.71-0.92) for benign and malignant breast lumps respectively. The procedure was well accepted and all the patients were willing to accept a repeat CNB and would recommend it. Conclusion: Despite the prevailing challenges, co-ordinated team diagnosis is feasible and may result in the modest improvement in the diagnostic accuracy of breast lesions and patient satisfaction.

 Accuracy of Clinical and Ultrasound Examination of Palpable Breast Lesions in a Resource Poor Society

Ebubedike UR, Umeh EO, Anyanwu SNC, Ihekwoaba EC, Egwuonwu OA, Ukah CO, Onwukamuche ME, Emegoakor CD, Onyiorah IV, Anyiam DD, Chianakwana GU

Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

Background and Objectives: Palpable breast masses are common presentations in resource poor societies. Clinical and ultrasonographic breast examinations are commonly available means of evaluation. The objective was too compare the accuracy of clinical breast examination and ultrasonography in the diagnosis of palpable breast masses. Materials and Methods: Consenting females presenting with palpable breast masses at the general surgical outpatient clinic were assessed clinically by the most senior surgeon, ultrasonographically by two radiologists and the diagnosis compared with histologic examination. Results: One hundred and thirteen patients were recruited during the study period, January 2015 to October 2016. Of these, 53 patients (46.9%) had breast core biopsy, while 60 [53.1%] had open surgical biopsy. Only 67 (59.3%) patients had their histological results available. The mean age was 41.58 years [Range 16-78]. Clinical breast examination achieved a sensitivity of 82.1%, specificity 67.9%, positive predictive value 78%, negative predictive value 73%, accuracy 76.1%, false positive rate 32.1%, false negative rate 17.9%. Breast ultrasonography had a sensitivity of 86.8%, specificity 72.4%, positive predictive value 80.5%, negative predictive value 80.8%, accuracy 80.6%, false positive rate 27.6%, false negative rate 13.2%. Conclusion: This study revealed no statistically significant difference between the accuracy of clinical breast examination and breast ultrasonography. We recommend both in the evaluation of palpable breast masses.

 Referral Pattern for Bone and Soft Tissue Tumours of the Extremities: Appeal for Early Referrals

Eyesan SU1, Itie JC2, Idowu OK3, Mbah EO3, Nnodu OE4, Abdulkareem FB5

1Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria,2Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria,3Department of Orthopaedics and Trauma Surgery, National Orthopaedic Hospital, Lagos, Nigeria,4Department of Haematology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria,5Department of Histopathology, Lagos University Teaching Hospital, Lagos, Nigeria

Background and Objectives: Bone and soft tissue neoplasms although rare, have poorer prognosis especially if malignant when there is a delay in diagnosis and treatment. This study aims to identify the referral pathway and factors that cause delay in diagnosis and institution of treatment in a resource constrained setting. Materials and Methods: This was a prospective study in 67 patients with musculoskeletal tumours over a 12 month period presenting at a specialist centre. Patients who consented to the study were interviewed to determine the duration of symptoms and signs, the source of referral and factors causing delay in the diagnostic pathway. Results: There were 41(61.2%) males and 26(38.8%) females with a mean age of 26.40years (range was 2years-65years). The mean duration of symptoms (patient delay) was 26.78 months (range was 2 months-120 months) while the mean delay in referral to a specialist centre ( first service delay) was 11.45weeks (range was 0.14-208weeks). The mean delay in diagnosis at the specialist centre (second service delay) was 5.53weeks (range was 0.14-52weeks). No statistically significant difference existed between gender, size of tumours and duration of symptoms as P > 0.05 in both instances. Five channels of presentation were identified based on the health care facility initially accessed by patients. Conclusion: Delay in the diagnosis of musculoskeletal tumours is still a major concern in resource constrained healthcare system as both patients and medical professionals play significant roles. The referral pattern enabled the development of an algorithm which will require revision as facilities improve.

 Improving Outcome for Musculoskeletal Tumour Through Communal Multidisciplinary Team

Eyesan SU1, Idowu OK2, Igbinoba B2, Habeebu MYM3, Nnodu OE4

1Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria,2Department of Orthopaedics and Trauma Surgery, National Orthopaedic Hospital, Lagos, Nigeria,3Department of Radio-oncology, LUTH, Lagos, Nigeria,4Department of Haematology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria

Background and Objectives: There are numerous challenges hindering the management of musculoskeletal tumours in low to medium income countries. Communal tumour boards through networking could be a viable option for effective management of musculoskeletal tumours. This study highlights the development of an integrated care pathway for patients with musculoskeletal tumours via multi institutional networking in the Lagos metropolis. Materials and Methods: Patients from different institutions in the Lagos metropolis were included for discussion at monthly meetings, under the aegis of the Lagos Musculoskeletal Oncology Network [LAMON]. The meetings ensured adherence as much as possible to agreed national and international guide lines in the management of musculoskeletal tumours. Decisions about surgery, chemotherapy, radiotherapy and timing of the modalities, were planned at the meetings. Results: The network extended to 26 volunteer specialists within the city. In the first 30 months, 212 patients were reviewed, of whom 192 (91%) patients had definitive histological diagnoses. The age range of the patients was 3-95 years. Limb salvage was achievable in 142 (67%) patients with a local recurrence rate of 8.5%. The common histological diagnoses include osteosarcoma 22%, giant cell tumour 13%, soft tissue sarcoma 11%, and metastatic bone disease 8%. Conclusion: The network resulted in improvement in diagnosis, limb salvage rate and follow up care for musculoskeletal tumours. Perhaps, with appropriate social and corporate support, communal tumour boards like LAMON may translate into model for multidisciplinary cancer care in resource poor environment like the west-African sub-region.

 Oestrogen, Progesterone, and HER-2 Receptors Status in Patients with Breast Cancer and Correlation with Disease Progression and Complication at the Lagos University Teaching Hospital

Ajiboye OA1, OlajideTO2, Banjo AAF3, Adesanya AA2, Atoyebi AO2

1Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria, Departments of2Surgery and3Anatomic and Molecular Pathology, Lagos University Teaching Hospital/College of Medicine of University of Lagos, Lagos, Nigeria

Background and Objectives: Response to varying treatment modalities for breast cancer is linked to cancer biology and expression of certain receptors. The aim of this study was to evaluate the receptor-status of patients at the Lagos University Teaching Hospital with breast cancer and determine any correlation with the stage of disease at presentation, disease progression and complication. Patients and Methods: This is a descriptive longitudinal study of 203 patients with breast cancer. Sociodemographic, clinical and radiologic evaluation and core needle biopsy were done following presentation and hormone receptor status of the specimens determined. Results: 200 (98.5%) patients were females and 3 (1.5%) were males. Mean age was 45.1 years ± 12.2 years. One hundred and eighty-five patients (91.1%) had invasive ductal carcinoma, 15 (7.4%) had invasive lobular carcinoma and 3 (1.5%) had other subtypes. Ninety-two (45.3%) were oestrogen receptor positive, 57 (28.1%) progesterone receptor positive and 48 (23.6%) HER2 receptor positive. Sixty-seven (37.4%) were triple receptor negative. One hundred and eighty-five (62.6%) presented in stage 3 while > 60% had duration of symptoms between < 4 months – 12 months. One hundred and ninety-two (94.6%) were node positive. The overall disease complication rate assessed by progressive metastatic disease was 50.2%. There was a correlation between receptor status and disease progression and complication. Conclusion: There was a predominance of triple receptor negative, young age and late stage at presentation, regional lymph node metastasis and aggressive behaviour of tumours depicted by short duration of symptoms. Receptor status demonstrated significant correlation with disease progression and complications.

 Gastric Cancer: Our Experience in Lagos University Teaching Hospital

Osinowo AO, Olajide TO, Lawal AO, Afolayan MO, Adesanya AA, Atoyebi OA

Department of Surgery, Lagos University Teaching Hospital/College of Medicine of University of Lagos, Lagos, Nigeria

Background and Objectives: Gastric cancer is not a common gastrointestinal malignancy in Nigeria but is an important cause of cancer morbidity and mortality in the last 3 decades. Objective: To compare the pattern of presentation and treatment outcome of patients with gastric cancer seen between 1991-2004 (Group I) and 2005-2018 (Group II). Patients and Methods: This is a retrospective study of patients diagnosed with gastric cancer seen at our centre over the last 3 decades. Data obtained from case notes included demographic data, pattern of presentation, diagnostic modality employed, histopathology, treatment and outcome. Results: Ninety patients were seen during the period reviewed; 46 patients in Group I and 44 patients in Group II. The mean age for the entire cohort was 56.4 ± 12.7. The male to female ratios were 1.9-1.0 and 1.75-1.0 respectively. Patients presented with epigastric pain (90%), weight loss (67.7%), anaemia (51.1%) and epigastric mass (44.4%). Diagnosis was confirmed by Barium meal in 32.2% and endoscopic biopsy in 65.5%. Histopathology revealed adenocarcinoma in 80 (88.9%) patients and located in the antrum in 77.5%. Surgery offered to patients included palliative subtotal gastrectomy (22), gastrojejunostomy (17), curative partial gastrectomy (15), nontherapeutic laparotomy (8), supraclavicular lymph node biopsy (1). Thirty-four patients died post-operatively and in follow-up period, 43 patients lost to follow-up, and 13 patients were still alive 6 months-2 years post-surgery. Conclusion: The outlook for gastric cancer in Nigeria is grim but can be improved by early endoscopy for patients with upper abdominal pain and primary prevention strategies.

 Conjunctival Squamous Cell Carcinoma in Onitsha Nigeria

Nwosu SNN, Nnubia CA, Akudinobi CU

Department of Ophthalmology, Guinness Eye Center, Nnamdi Azikiwe University Awka, Onitsha, Anambra State, Nigeria

Objectives: To describe the incidence and pattern of conjunctival squamous cell carcinoma at the Guinness Eye Center Onitsha. Materials and Methods: The case files of all patients with ocular and adnexal tumors at the Guinness Eye Center Onitsha between 2005 and 2017 were reviewed. Those with histological diagnosis of conjunctival squamous cell carcinoma were selected and analyzed. Information obtained included age, sex, disease duration, diagnosis and co-morbidity. Results: There were 30 patients (0.03% of new all patients and 35.3% of all ocular and adnexal cancers); age range-25-70 years; median age-33 years; 13 males and 17 females. Twenty-eight out of the 30 (93.3%) patients were HIV-positive. All were unilateral. Metastasis to the ocular adnexa was recorded in 2 patients. Conclusions: The incidence of conjunctival squamous cell carcinoma was our hospital was at least 0.03%. It occurred commonly young adults most of who were also HIV positive.

 Gastrointestinal Mesenchymal Tumours in Lagos: Review of Twelve Cases

Balogun OS, Osinowo AO, Da Rocha Afodu JT

Department of Surgery, Lagos University Teaching Hospital/College of Medicine of University of Lagos, Lagos, Nigeria

Background and Objectives: Gastrointestinal mesenchymal tumours (GMT)are rare heterogeneous neoplasms with variable biologic behaviour. Gastrointestinal stromal tumours (GIST) are the most common type of GMT and an important differential diagnosis of massive upper gastro-intestinal bleeding. This study focusses of the presentation and management of GMT in our centre. Patients and Methods: this is a case series of 12 patients,18 years and above managed for GMT at the Lagos University Teaching Hospital between November 2015 and February 2019. Results: There were 7 males and 5 females giving a ratio of 1.4:1. The mean age at presentation was 53.4 years. Duration of symptoms ranged from 2 days to 4 years. Two-third (66.7%) of patients presented after 6 months of onset. The main presenting symptoms were: abdominal pain (91.6%), abdominal mass (66.7%) and weight loss (41.7%). Five (41.7%) patients presented with malaena. Haematemesis occurred in only 1 patient. Ulcerated gastric tumour was found in 4 patients on gastroscopy. Radiologically, 8 (66.7%) cases were gastric; 2 (16.7%) were jejunal in origin. Widespread peritoneal metastasis occurred in 2 patients. Surgical resection was performed in 10 (83.3%) patients. Two (16.7%) patients had tumour de-bulking surgery. Histologically, GMT size ranged from 4 to 16 cm. Four (33.3%) cases of GMT were confirmed as GIST on immunohistochemistry. The two (16, 7%) post-operative mortalities in this series were in patients with recurrent and advanced disease. Conclusion: GMT are relatively uncommon with delayed presentation. Few cases have been managed by us over the last 3 years. Most GMT in this series were of gastric origin and abdominal pain was the most common symptom. Melaena was recorded in less.

 Management Outcome of Wilms Tumor-Going Beyond Our Limits: A Five-Year Experience from a Tertiary Hospital in West Africa

Alakaloko FM1, Adeseye AM2, Seyi-Olajide JO1, Ladipo-Ajayi O1, Elebute O3, Ademuyiwa AO3, Bode C3

1Department of Surgery, Pediatric Surgery Unit, Lagos University Teaching Hospital,2Department of Pediatrics, Paediatric Hematology and Oncology Unit, College of Medicine, University of Lagos,3Department of Surgery, Paediatric Surgery Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Surulere, Lagos

Background and Objectives: Management of Wilms Tumor has evolved over the last few decades with an overall survival rate of about 85% in HICs. This is attributable to a collaborative effort between pediatric surgeons, pediatric oncologists, pathologists and radiation oncologists. The survival rates from LMICs are still low, and some of the challenges faced are delays at all levels of care, paltry coverage of health insurance, absence of pediatric cancer centers and research laboratories. This study aims at auditing a domicile institution protocol for Wilms tumor care. Materials and Methods: A five-year retrospective review of our center. Data was extracted from patients' case notes, operation notes and ward admission records, Data analysis was with SPSS 25, and P value was < 0.005. Results: Forty patients were recruited over the study period with a slight male preponderance; two-thirds of our patients were stage 3 disease while about 57.5% were right sided tumor and 42.5% on the left side. The average duration of symptoms was 3.6 months (range 1-7 months), all our patients presented with an abdominal mass and all the patients were assessed with USS, CT scan and Chest x-ray. 65% completed the chemotherapy courses and about 75% had survived beyond one year of multi-modal treatment. Conclusion: The improvement we have observed is related to the development of our institution wilms protocol pathway and the synergy fostered between pediatric surgeon and pediatric oncologist. There is need for community awareness drive to improve the presentation-intervention time.

 Immediate Post Mastectomy Breast Reconstruction: A Feasible Option in Resource Constrained Settings

Olawoye OA, Ademola SA, Iyun AO, Michael IA, Oluwatosin OM, Aderibigbe RO

Department of Plastic Surgery, University College Hospital, Ibadan, Nigeria

Background: Breast cancer is adjudged to be the commonest female malignancy in Nigeria and a major modality of treatment is mastectomy. However, married Nigerian women are known to suffer significant psychosocial difficulties following treatment for primary breast cancer. A few suggestions have been made on ways to mitigate these difficulties with varying degree of success attending their use. Unfortunately, immediate breast reconstruction is not prominent among the options made available to women who are scheduled to undergo mastectomy due to various challenges often encountered in the management of the patients. The aim of this report is to demonstrate the feasibility of immediate post mastectomy breast reconstruction in resource constrained settings and encourage breast surgeons to include this option in the routine treatment plan for patients with breast cancer. Methods: A 34 year old patient was diagnosed to have early right breast cancer and was scheduled for mastectomy and immediate breast reconstruction. The patient had preoperative preparation as per institutional protocol. Close collaboration between the oncologic surgeon and plastic surgeon was employed in order to preserve the skin envelop at mastectomy. A pedicled transverse rectus abdominis musculocutaneous flap based on the left superior epigastric artery was raised for immediate breast reconstruction. Result: The patient made an uneventful post-operative recovery and there was good volume match compared with the left breast. A series of patients with early breast cancer who were scheduled for mastectomy and immediate breast reconstruction between 2017and 2019 had either pedicled transverse rectus abdominis muscle or latissimus dorsi muscle flap transfers with good outcomes. Conclusion: Routinely raised flaps by plastic surgeons can be successfully used for immediate breast reconstruction without recourse to use of expensive infrastructure. Assurance to the patient that her breast would have been 'replaced by a new one' by the time she recovers from anaesthesia may serve as encouragement for mastectomy to be more readily acceptable at early stage of disease rather than late acceptance that is currently rampant. Close collaboration between oncologic surgeons and plastic surgeons is however essential for increased acceptance and uptake for immediate breast reconstruction and sustained successful outcomes.