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Surgical resection improves overall survival of patients with small bowel leiomyosarcoma

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Small bowel leiomyosarcoma (SB LMS) is a rare disease with few studies characterizing its outcomes. This study aims to evaluate surgical outcomes for patients with SB LMS.

Methods

The National Cancer Database was queried from 2004 to 2016 to identify patients with SB LMS who underwent surgical resection. The primary outcome was overall survival.

Results

A total of 288 patients with SB LMS who had undergone surgical resection were identified. The median age was 63, and the majority of patients were female (56%), White (82%), and had a Charlson comorbidity score of zero (76%). Eighty-one percent of patients had negative margins following surgical resection. Fourteen percent of patients had metastatic disease at the time of diagnosis. Nineteen percent of patients received chemotherapy and 3% of patients received radiation. One-year overall survival was 77% (95% CI: 72–82%) and 5-year overall survival was 43% (95% CI: 36–49%). Higher grade (HR: 1.98, 95% CI: 1.10–3.55, p = 0.02) and metastatic disease at diagnosis (HR: 2.57, 95% CI: 1.45–4.55, p = 0.001) were independently associated with higher risk of death.

Conclusion

SB LMS is a rare disease entity, with treatment centering on complete surgical resection. Our results demonstrate that overall survival is higher than previously thought. Timely diagnosis to allow for complete surgical resection is key, and investigation into the possible role of chemotherapy or radiation therapy is needed.

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Data availability

The data that support the findings of this study are available from the National Cancer Database. Restrictions apply to the availability of these data, which were used under license for this study. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Author notes

  1. Vanessa M. Welten and Adam C. Fields contributed equally to this work.

Authors and Affiliations

  1. Division of General and GI Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Vanessa M. Welten, Adam C. Fields, Pamela W. Lu, James Yoo, Joel E. Goldberg, Jennifer Irani, Ronald Bleday & Nelya Melnitchouk

  2. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Pamela W. Lu & Nelya Melnitchouk

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  1. Vanessa M. Welten
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All authors had substantial contributions to design of work, drafted work, made final approval, and agreed to be accountable for all aspects of the work.

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Correspondence to Vanessa M. Welten.

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Welten, V.M., Fields, A.C., Lu, P.W. et al. Surgical resection improves overall survival of patients with small bowel leiomyosarcoma. Int J Colorectal Dis 35, 2283–2291 (2020). https://doi.org/10.1007/s00384-020-03718-4

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