Skip to main content

Advertisement

Log in

Current Oncologic Standards for Surgery of Small Bowel Cancers

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Purpose

The last 2 decades has witnessed efforts towards standardization of surgery for small bowel cancers. The proposed recent guidelines/recommendations pertaining to choice of procedure and extent of lymphadenectomy are based on analysis of data from high volume centres of excellence. We evaluated whether these recently proposed oncologic recommendations can be replicated in the setting of single centre/team.

Methods

This was a retrospective analysis of consecutive adult patients (age ≥ 18 years) who underwent surgery for tumours of small intestine (duodenum, jejunum, and ileum) by the same team of surgeons from 01/01/2010 to 12/31/2019. The procedure performed and lymph nodes harvested during pathologic examination were compared with recent recommendations.

Results

Of the 32 patients (20 males and 12 females), mean age was 52.4 (range 31–77) years. Twenty-nine (90.6%) patients underwent surgery for small bowel cancers. Duodenum was the most common site, while NET was the commonest cancer. Whipple’s procedure was performed for tumours of II part of duodenum, while for the rest, segmental resection was performed. The median number of lymph nodes examined for duodenal adenocarcinoma and NET was 14 and 9, respectively. For jejunal/ileal adenocarcinoma, median lymph node number examined was 11.

Conclusion

Our study shows that these recently proposed standards for surgery of small bowel cancers are achievable if basic principles of oncologic surgery are followed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Inoue Y, Hayashi M, Satou N, et al. Prognostic clinicopathological factors after curative resection of small bowel adenocarcinoma. J Gastrointest Cancer. 2012;43(2):272–8.

    Article  CAS  Google Scholar 

  2. Benson AB, Venook AP, Al-Hawary MM, et al. Small bowel adenocarcinoma: NCCN Guidelines. J Natl Compr Canc Netw. 2019;17(9):1109–33.

    Google Scholar 

  3. Locher C, Batumona B, Afchain P, et al. Thésaurus National de Cancérologie Digestive (TNCD). Small bowel adenocarcinoma: French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis 2018;50(1):15-19.

  4. Bilimoria KY, Bentrem DJ, Wayne JD, et al. Small bowel cancers in the United States: changes in epidemiology, treatment and survival over the last 20 years. Ann Surg. 2009;249(1):63–71.

    Article  Google Scholar 

  5. Meijer L, Alberga A, de Bakker J, et al. Outcomes and treatment options for duodenal adenocarcinomas. A systematic review and meta-analysis. Ann Surg Oncol. 2018;25:2681-2692.

  6. Tran T, Qadan M, Dua M, et al. Prognostic value of lymph node ratio and total lymph node count for small bowel adenocarcinoma. Surgery. 2015;158(2):486–93.

    Article  Google Scholar 

  7. Wilhelm A, Muller S, Steffen T, et al. Patients with adenocarcinoma of small intestine with 9 or more lymph nodes retrieved have higher rate of positive lymph nodes and improved survival. J Gastrointest Surg. 2016;20(2):401–10.

    Article  Google Scholar 

  8. Gamboa A, Liu Y, Lee R, et al. Duodenal neuroendocrine tumors. Somewhere between the pancreas and small bowel. J Surg Oncol. 2019;120(8);1293 – 1301.

  9. Fave GD, O’Toole D, Sundin A, Taal B, Ferolla P, Ramage JK, et al. ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology. 2016;103(2):119–24.

    Article  Google Scholar 

  10. Dogeas E, Cameron JL, Wolfgang CL, et al. Duodenal and ampullary carcinoid tumors: size predicts necessity for lymphadenectomy. J Gastrointest Surg. 2017;21:1262–9.

    Article  Google Scholar 

  11. Motz BM, Lorimer PD, Boselli D, et al. Optimal lymphadenectomy in small bowel neuroendocrine tumors. Analysis of the NCDB. J Gastrointest Surg. 2018;22(1);117-123.

  12. Zaidi M, Augir AL, Dillhoff M, et al. Prognostic role of lymph node positivity and number of lymph nodes needed for accurately staging small bowel neuroendocrine tumors JAMA Surg. 2019;154(2):134–40.

    PubMed  Google Scholar 

  13. Shah MA, Goldner WS, Benson AB, et al. Neuroendocrine and adrenal tumors version 2.2020. NCCN clinical practice guidelines in oncology (NCCN Guidelines); NE-D.

  14. Maxwell JE, Sherman SK, O’Dorision TM, et al. Liver directed surgery of neuroendocrine metastases: what is the optimal strategy? Surgery. 2016;159(1):320–33.

    Article  Google Scholar 

  15. Boonstra PA, Steeghs N, Farag S, et al. Surgical and medical management of small bowel gastrointestinal stromal tumor: a report of the Dutch GIST registry. Eur J SurgOncol. 2019;45(3):410–5.

    Article  CAS  Google Scholar 

  16. Chok A, Koh Y, Ow M, et al. A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal tumors. Ann SurgOncol. 2014;21(11):3429–38.

    Google Scholar 

  17. Zhang Q, Shou CH, Yang WL, et al. Prognostic characteristics of duodenal gastrointestinal stromal tumors. Br J Surg. 2015;102(8):959–64.

    Article  CAS  Google Scholar 

  18. Lightner A, Shannon E, Gibbons M, et al. Primary gastrointestinal non-Hodgkin’s lymphoma of the small and large intestine: a systematic review. J GastrointestSurg. 2016;20(4):827–39.

    Article  Google Scholar 

  19. Nathan H, Shore A, Anders R. Variation in lymph node assessment after colon cancer resection. Patient, Surgeon, Pathologist or Hospital. J Gastrointest Surg. 2011;15(3):471-79.

  20. Sohn T, Lillemoe K, Cameron J, et al. Adenocarcinoma of the duodenum:factors influencing long-term survival. J gastrointestSurg. 1998;2(1):79–87.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dinesh Singhal.

Ethics declarations

Ethics Approval

Provided by Institutional Ethics Committee

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vashistha, N., Singhal, D. Current Oncologic Standards for Surgery of Small Bowel Cancers. J Gastrointest Canc 53, 434–438 (2022). https://doi.org/10.1007/s12029-021-00635-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-021-00635-9

Keywords

Navigation