Ann Ital Chir. 2022;92.
In this paper we report on our experience of diagnosis, treatment and follow up of cases of cancer of the oesophagus treated in Balbala Cheiko Hospital and in the Djibouty Military Hospital. Oesophageal cancer, mainly squamous cellular type, is the prevalent cancer of the gastrointestinal tract (GIT) observed in our two Hospitals. Djibouti is a small pacific country located in the Horn of Africa in the tropics, bordered by Somaliland in the south, Ethiopia in the southwest, Eritrea in the north and the Red Sea and the Gulf of Aden in the east. Yemen lies across the Gulf of Aden. Djibouti is the principal maritime port for Ethiopia. The country was formerly French Somaliland and it became independent from France in June 1977. It is a multi-ethnic nation with a population of just over 900,000.
From January 2011 to April 2021, we observed 159 patients diagnosed with cancer of the oesophagus: 89 females representing 56 % and 70 males representing 44 %. An Oesophageal Cancer Card (see Annex 1) was completed for each patient. 107 patients (67.30%) reported regularly (twice a week) chewing of khat (see Annex 2) and 68 patients (42,76%) regularly smoked more than 20 cigarettes and drank more than three very hot cups of coffee or tea per day. All patients underwent an oesophagoscopy with biopsy. Squamous Cell Carcinoma (OSCC) was confirmed by histology in all cases, 89 of them being females (64%) which is surprisingly different from data reported in the literature which reports a general prevalence of males. 60 patients (37.7 % of the total) underwent surgery. The Ivor-Lewis operation was the most frequent type of surgery and was done in 44 patients (66.6%).
Our ten years experience involved two hospitals serving a large area. Cancer of the oesophagus (OC) was the prevalent gastrointestinal cancer we observed, second only to female breast cancer. There are no facilities in the country for radiotherapy. It is very difficult to report on long term survival because most of patients live in rural areas which are very difficult to reach and they rarely return for medical check-ups. The best survival recorded was a 48 year old Afar male who was still alive 6 years after an Ivor-Lewis operation was performed for squamous carcinoma on 3 April 2014 and checked on September 2020. A further 6 patients (2 males and 4 females, 3 with adenocarcinoma and 3 with squamous cell carcinoma) recently checked are still alive and come in regularly for check-up.
Oesophageal cancer is one of the most frequent cancers found in the Horn of Africa and our experience in Djibouti confirms the data of the literature 16,28,29. A peculiarity in our study is the high prevalence in the female population. Our recommendation is to set-up an oesophageal cancer unit (OCU) with a team of specialists: gastroenterologist, surgical oncologist, anaesthesiologists, pathologists, nutritionalists and trained nurses who could ensure, not only hospital support, but also the active post operative follow up of patients. The implementation of a National Cancer Register would be mandatory.
Oesophageal Cancer, Ivor Lewis Operation, Follow up, Djibouti.
本文报告了我们在巴尔巴拉切科医院和吉布提军事医院治疗和随访食管癌症病例的经验。食管癌症，主要是鳞状细胞类型，是我们两家医院观察到的胃肠道（GIT）中常见的癌症。吉布提是一个位于非洲之角的太平洋小国，南部与索马里兰接壤，西南部与埃塞俄比亚接壤，北部与厄立特里亚接壤，东部与红海和亚丁湾接壤。也门位于亚丁湾对面。吉布提是埃塞俄比亚的主要海港。该国以前是法属索马里兰，1977 年 6 月从法国独立。它是一个多民族国家，人口刚刚超过 90 万。
从 2011 年 1 月到 2021 年 4 月，我们观察了 159 名被诊断为食管癌的患者：89 名女性占 56%，70 名男性占 44%。为每位患者填写了一张食管癌卡片（见附件 1）。107 名患者（67.30%）经常咀嚼阿拉伯茶（见附件 2），每周两次，68 名患者（42.76%）经常每天吸烟超过 20 支香烟和饮用三杯以上非常热的咖啡或茶。所有患者均接受食管镜检查和活检。所有病例均通过组织学证实为鳞状细胞癌（OSCC），其中 89 例为女性（64%），这与文献报道的数据明显不同，文献报道男性一般患病率较高。60 名患者（占总数的 37.7%）接受了手术。最常见的手术类型是 Ivor-Lewis 手术，有 44 名患者（66.6%）接受了该手术。
我们十年的经验涉及两家服务于大地区的医院。食管癌（OC）是我们观察到的最常见的胃肠道癌症，仅次于女性乳腺癌。该国没有放射治疗设施。由于大多数患者居住在农村地区，很难到达，而且很少返回进行医疗检查，因此很难报告长期生存情况。记录的最佳生存情况是一名 48 岁的阿法尔男性，他于 2014 年 4 月 3 日因鳞状细胞癌接受 Ivor-Lewis 手术后，仍然存活，2020 年 9 月接受检查。另外 6 名患者（2 名男性和 4 名女性，3 名腺癌和 3 名鳞状细胞癌）最近检查仍存活，定期接受检查。
食管癌是非洲之角最常见的癌症之一，我们在吉布提的经验证实了文献 16、28、29 的数据。我们研究的一个特点是女性人群中的高患病率。我们的建议是建立一个食管癌单位（OCU），由一组专家组成：胃肠病学家、外科肿瘤学家、麻醉师、病理学家、营养师和经过培训的护士，他们不仅可以提供医院支持，还可以对患者进行积极的术后随访。必须建立国家癌症登记处。
食管癌、Ivor Lewis 手术、随访、吉布提。
