Abstract Background Lymphoma real-world observational data and accurate diagnostic systems are lacking in low-resource HIV-endemic settings. We established a new lymphoma registry to generate internationally comparable, clinically validated data, with up-to-date disease classification. We also describe our findings on aggressive B-cell lymphoma. Methods The descriptive retrospective cohort included patients ≥ 13 years of age newly diagnosed with lymphoma from 2005 to 2020. Patients were enrolled at a single site in a registry with hierarchical groupings to capture, interrogate, and subtype lymphoma diagnoses. These were standardised on the most recent version of the World Health Organisation Classification of Haematolymphoid Tumours (WHO-HAEM5) and correlated with the novel International Consensus Classification of mature lymphoid neoplasms (ICC). Differences due to nomenclature and diagnostic category were annotated. Results The cohort consisted of 2354 incident lymphoma cases; 1891 (80.3%) non-Hodgkin lymphoma and 463 (19.7%) Hodgkin lymphoma (HL). Twenty-one lymphoma NOS cases were excluded due to inadequate specimen for standardised subclassification. Overall reclassification according to WHO-HAEM5 was 25.8% (n = 608). Notable nomenclature differences between WHO-HAEM5 and ICC included 44 (1.9%) transformations of indolent B-cell lymphomas; also 857 (36.4%) lymphoid proliferations and lymphomas associated with immune deficiency/dysregulation due to HIV (33.1%) and EBV (31.8%). EBV-association was highest among HL cases, of which 77 (50.3%) were HIV reactive. Conclusion We report here the impact of adopting international lymphoma classification standards in an HIV-endemic setting. Our findings highlight the persistent prevalence of large B-cell lymphoma, raise concern around inadequate HIV suppression as a potential ongoing driver of disease in our setting, and provide further evidence for EBV-associated HL as a distinct subtype.
Aims:Surgical management of intermediate and malignant tumours in the pelvis is complex. Complications are frequent and either related to the surgery itself or to post-surgical failure of the reconstruction technique. This systematic review and meta-analysis aims at analyzing all reported complications following PI to PIII pelvic resections for intermediate and malignant tumours. Methods:Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis. Results:Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001). Conclusion:Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs.
Background: South Africa has a high mortality-to- incidence ratio for colon cancer, highlighting the poor outcome relative to incidence and underscoring the urgent need for public health action. Costing studies can be leveraged to understand the treatment cost burden, providing crucial insights for resource allocation. This study aimed to estimate the treatment costs for colon cancer by stage, from the perspective of healthcare providers at a tertiary healthcare facility in South Africa. Methods: An ingredient-based approach was used to assess the stage-specific treatment costs of colon cancer at a South African tertiary academic hospital. A two-step costing process was adopted. First, treatment components were defined based on facility guidelines and verified through expert interviews, linking these components to relevant cost items for each cancer stage. Second, a bottom-up costing method was used to estimate and aggregate per-patient costs across treatment components for each stage. All capital items were annuitised using a rate of 3% and sensitivity analyses were conducted. All costs are reported in South African Rands (ZAR) and United States Dollars (USD) as per 2024 exchange rates. Results: Identified colon cancer treatment components at the tertiary hospital include staging and risk assessment investigations, clinical consultations, surgery and chemotherapy. The estimated per-patient costs for treatment were R60,156 ($3216) for stages I and II (low-risk); R75,132 ($4017) for high-risk stage II and stage III; and R171,935 ($9193) for stage IV(resectable cases). Surgery represents a major treatment cost driver. Conclusion: Colon cancer treatment costs are substantial and increase with advancing stage. These findings highlight the potential cost savings from promoting early colon cancer diagnosis. Policy Summary : To mitigate these rising costs and reduce the healthcare burden, policies should prioritise early detection and invest in accessible, stage-appropriate interventions that improve patient outcomes and saves cost.
Background Enteral access is considered the most physiological and beneficial feeding route. Percutaneous endoscopic gastrostomy (PEG) is widely used for enteral feeding in patients with functional gastrointestinal systems, but who are unable to maintain sufficient oral intake to meet daily nutritional and metabolic needs. PEG-related complications can be significant, but reported rates are variable.Aim To investigate the use, complications, and outcomes associated with PEG insertion in a South African tertiary-level centre.Methods Retrospective study including all patients who underwent PEG insertion at the Groote Schuur Hospital Gastroenterology Unit between March 2018 and June 2023. Variables obtained included patient demographics, comorbidities, PEG insertion details, and complications.Results A total of 149 patients undergoing 158 PEG-insertion procedures were included with a median age of 54 years (IQR: 38–64) with the majority being male (91; 61.1%). The most common indication for PEG insertion was cerebrovascular accident (CVA) at 25.5%. PEG-related complications were divided into three: insertion-related, early (within 30 days of insertion), and late (after 30 days of insertion) and observed in 64 patients (43.0%). The only factor found to be associated with an increased early complication rate was the size of the PEG, with 24Fr tubes having a higher complication rate compared with smaller tubes (25.5% vs. 3.7%, p < 0.001).Conclusions Local indications and high complication rates of PEG placement are highlighted, advocating for the judicial placement of PEGs. Early complications are notably higher with increased diameter tubing, and it is recommended that the use of 24Fr tubes be avoided if possible.
