Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2007

01-08-2007 | Gastrointestinal Oncology

Surgical Management and Outcome in Primary Adenocarcinoma of the Small Bowel

Authors: Shefali Agrawal, MD, Edward C. McCarron, MD, John F. Gibbs, MD, Hector R. Nava, MD, Gregory E. Wilding, PhD, Ashwani Rajput, MD

Published in: Annals of Surgical Oncology | Issue 8/2007

Login to get access

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.
Literature
1.
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; 86:2693–2706PubMedCrossRef
2.
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; 101:518–526PubMedCrossRef
3.
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):183–188PubMedCrossRef
4.
Ito H, Perez A, Brooks DC, et al. Surgical treatment of small bowel cancer: a 20-year single institution experience. J Gastrointest Surg 2003; 7:925–930PubMedCrossRef
5.
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):300–306PubMedCrossRef
6.
Frost DB, Mercado PD, Tyrell JS. Small bowel cancer: a 30-year review. Ann Surg Oncol 1994; 1(4):290–295PubMedCrossRef
7.
Zollinger RM, Sternfeld WC, Schreiber H. Primary neoplasms of the small intestine. Am J Surg 1986; 15:654–658CrossRef
8.
Naef M, Buhlmann M, Baer HU. Small bowel tumors: diagnosis, therapy and prognostic factors. Langenbecks Arch Surg 1999; 384:176–180PubMedCrossRef
9.
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; 151:9–14PubMed
10.
Santoro E, Sacchi M, Scutari F, Carboni F, Grazioni F. Primary adenocarcinoma of the duodenum: treatment and survival in 89 patients. Hepatogastroenterology 1997; 44:1157–1163PubMed
11.
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; 2:79–87PubMedCrossRef
12.
Bakaeen FG, Murr M, Sarr MG, et al. What prognostic factors are important in duodenal adenocarcinoma. Arch Surg 2000; 135(6):635–642PubMedCrossRef
13.
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; 173:237–239PubMedCrossRef
14.
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):73–78PubMedCrossRef
15.
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; 48:727–732PubMed
16.
Lambert P, Minghini A, Pincus W, Kolm P, Perry RR. Treatment and prognosis of primary malignant small bowel tumors. Am Surg 1996; 62(9):709–715PubMed
17.
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; 25:722–728PubMedCrossRef
18.
Stell D, Mayer D, Mirza D, Buckels J. Delayed diagnosis and lower resection rate of adenocarcinoma of the distal duodenum. Dig Surg 2004; 21:434–439PubMedCrossRef
19.
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):304–308PubMed
20.
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):225–231PubMedCrossRef
21.
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):290–294PubMedCrossRef
Metadata
Title
Surgical Management and Outcome in Primary Adenocarcinoma of the Small Bowel
Authors
Shefali Agrawal, MD
Edward C. McCarron, MD
John F. Gibbs, MD
Hector R. Nava, MD
Gregory E. Wilding, PhD
Ashwani Rajput, MD
Publication date
01-08-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 8/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9428-2

Other articles of this Issue 8/2007

Annals of Surgical Oncology 8/2007 Go to the issue

Breast Oncology

Preoperative Lymphoscintigraphy Predicts the Successful Identification but Is Not Necessary in Sentinel Lymph Nodes Biopsy in Breast Cancer

Thoracic Oncology

Margin and Local Recurrence After Sublobar Resection of Non-Small Cell Lung Cancer

Editorial

Lymphatic Mapping and Sentinel Lymph Node Biopsy for Locally Recurrent Breast Cancer: New Clues to Understanding the Biology of Chest Wall Relapse

Breast Oncology

Superiority of Sonographic Hematoma Guided Resection of Mammogram Only Visible Breast Cancer: Wire Localization Should be an Exception—Not the Rule

EditorialNotes

Resecting Lymph Nodes in Colon Cancer: More than a Staging Operation?

Gynecologic Oncology

Laparoscopic Sentinel Node Biopsy in Cervical Cancer Using a Combined Detection: 5–Years Experience