Abstract
Background
Primary adenocarcinoma of the small bowel is a rare malignancy and is associated with poor survival outcome. Patient, tumor and treatment-related factors were analyzed for their association with recurrence and survival.
Methods
Between 1971 and 2005, 64 patients with primary adenocarcinoma of the small bowel were treated at our institution. Clinico-pathologic data, operative details, postoperative treatment, recurrence pattern and survival were reviewed.
Results
The most common clinical features at presentation included abdominal pain (n = 33; 51.6%) or bowel obstruction (n = 20; 31.3%). The most frequently involved portion of the small bowel was the duodenum (n = 41; 64%). A segmental bowel resection was performed in 30 patients and pancreaticoduodenectomy in 14 patients. Postoperative mortality and morbidity rates were 3.6% (n = 2) and 14.5% (n = 8), respectively. Of the 55 patients who underwent operative intervention, a curative resection was performed in 30 (54.5%). The most common sites of recurrence following a curative resection were the liver and lung. Median survival for all 64 patients was 18 months with a 5-year survival of 21.1%. On multivariate analysis, absence of distant metastatic disease (5-year survival 30.4%), curative resection (5-year survival 44.8%) and pathological T stage 1-3 (5-year survival 39.2%) were identified as independent predictors of survival.
Conclusions
A curative resection in the absence of both distant metastases and pathological T4 tumor provides the best survival outcome. Recurrence at distant sites is the predominant pattern of failure following a curative resection, suggesting a role for adjuvant therapy.
Similar content being viewed by others
References
Howe JR, Karnell LH, Menck HR, Scott-Conner C. Adenocarcinoma of the small bowel. Review of the National Cancer Data Base 1985–1995. Cancer 1999; 86:2693–2706
Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J. Adenocarcinoma of the small bowel. Presentation, prognostic factors and outcome of 217 patients. Cancer 2004; 101:518–526
Bauer RL, Palmer ML, Bauer AM, Nava HR, Douglass HO. Adenocarcinoma of the small intestine: 21-year review of diagnosis, treatment and prognosis. Ann Surg Oncol 1994; 1(3):183–188
Ito H, Perez A, Brooks DC, et al. Surgical treatment of small bowel cancer: a 20-year single institution experience. J Gastrointest Surg 2003; 7:925–930
Cunningham JD, Aleali R, Aleali M, Brower ST, Aufses AH. Malignant small bowel neoplasms: histopathologic determinants of recurrence and survival. Ann Surg 1997; 225(3):300–306
Frost DB, Mercado PD, Tyrell JS. Small bowel cancer: a 30-year review. Ann Surg Oncol 1994; 1(4):290–295
Zollinger RM, Sternfeld WC, Schreiber H. Primary neoplasms of the small intestine. Am J Surg 1986; 15:654–658
Naef M, Buhlmann M, Baer HU. Small bowel tumors: diagnosis, therapy and prognostic factors. Langenbecks Arch Surg 1999; 384:176–180
Awrich AE, Irish CE, Vetto RM, Fletcher WS. A twenty-five year experience with primary malignant tumors of the small intestine. Surg Gynecol Obstet 1980; 151:9–14
Santoro E, Sacchi M, Scutari F, Carboni F, Grazioni F. Primary adenocarcinoma of the duodenum: treatment and survival in 89 patients. Hepatogastroenterology 1997; 44:1157–1163
Sohn TA, Lillemoe KD, Cameron JL, Pitt HA, Kaufman HS, Hruban RH, Yeo CJ. Adenocarcinoma of the duodenum: Factors influencing long-term survival. J Gastrointest Surg 1998; 2:79–87
Bakaeen FG, Murr M, Sarr MG, et al. What prognostic factors are important in duodenal adenocarcinoma. Arch Surg 2000; 135(6):635–642
Veyrieres M, Baillet P, Hay JM, Fingerhut A, Bouillot JL, Julien M. factors influencing long-term survival in 100 cases of small intestine primary adenocarcinoma. Am J Surg 1997; 173:237–239
Barnes G, Romero L, Hess KR, Curley SA. Primary adenocarcinoma of the duodenum: management and survival in 67 patients. Ann Surg Oncol 1994; 1(1):73–78
Brucher BLDM, Stein HJ, Roder JD, Busch R, Fink U, Werner M, Siewert JR. New aspects of prognostic factors in adenocarcinomas of the small bowel. Hepatogastroenterology 2001; 48:727–732
Lambert P, Minghini A, Pincus W, Kolm P, Perry RR. Treatment and prognosis of primary malignant small bowel tumors. Am Surg 1996; 62(9):709–715
Chow JS, Chen CC, Ahsan H, Neugut AI. A population-based study of the incidence of malignant small bowel tumors: SEER, 1973–1990. Int J Epidemiol 1996; 25:722–728
Stell D, Mayer D, Mirza D, Buckels J. Delayed diagnosis and lower resection rate of adenocarcinoma of the distal duodenum. Dig Surg 2004; 21:434–439
Maglinte DDT, O’Connor K, Bessette J, Chernish SM, Kelvin FM. The role of the physician in the late diagnosis of primary malignant tumors of the small intestine. Am J Gastroenterol 1991; 86(3):304–308
Fishman PN, Pond GR, Moore MJ, et al. Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases. Am J Clin Oncol 2006; 29(3):225–231
Locher C, Malka D, Boige V, Lebray P, Elias D, Lasser P, Ducreux M. Combination chemotherapy in advanced small bowel adenocarcinoma. Oncology 2005; 69(4):290–294
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Agrawal, S., McCarron, E.C., Gibbs, J.F. et al. Surgical Management and Outcome in Primary Adenocarcinoma of the Small Bowel. Ann Surg Oncol 14, 2263–2269 (2007). https://doi.org/10.1245/s10434-007-9428-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-007-9428-2