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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2010

01-10-2010 | Gastrointestinal Oncology

Small Bowel Adenocarcinoma: Understaged and Undertreated?

Authors: Michael B. Nicholl, MD, Vanita Ahuja, MD, W. Charles Conway, MD, Vu D. Vu, BSc, Myung-Shin Sim, DrPH, Gagandeep Singh, MD

Published in: Annals of Surgical Oncology | Issue 10/2010

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Abstract

Background

Primary small bowel adenocarcinoma (SBA) is a rare, chemoresistant tumor with an aggressive clinical nature. Surgery is the mainstay of therapy, but the extent of lymph node (LN) recovery necessary for optimal care of jejunoileal SBA is unknown.

Materials and Methods

The SEER database was queried to identify patients whose primary jejunoileal SBA was diagnosed between 1995 and 2005. Patients were grouped by AJCC stage and number of LNs recovered from the surgical specimen.

Results

Of 1444 patients with primary SBA, 93 (6.4%), 529 (36.6%), 356 (24.7%), and 466 (32.3%) were initially diagnosed with stage I, II, III, and IV disease, respectively. Five-year overall survival (OS) rate was 59.8%, 39.5%, 27.0%, and 3.2% for patients with stage I, II, III, and IV SBA, respectively. When ≥10 nodes were recovered, OS rate increased nonsignificantly in stage I (73.2% vs. 55.6%) and significantly in stage II (61.8% vs. 32.9%, P < .001) but was unchanged in stage III (27.4% vs. 27.3%, P = .13). Recovery of ≥10 nodes occurred in 26.9%, 23.6%, and 42.1% of patients with stage I, II, and III SBA, respectively. Multivariate analysis identified age, AJCC stage, site of primary tumor, recovery of ≥10 LNs, and number of positive nodes as significant for OS.

Conclusions

We have found SBA staging is largely inadequate. Our results suggest recovery of ≥10 LNs ensures accurate staging. Improvement in stage II SBA OS after adequate LN may reflect a high degree of understaging in this dataset rather than a therapeutic effect of LAD.
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Metadata
Title
Small Bowel Adenocarcinoma: Understaged and Undertreated?
Authors
Michael B. Nicholl, MD
Vanita Ahuja, MD
W. Charles Conway, MD
Vu D. Vu, BSc
Myung-Shin Sim, DrPH
Gagandeep Singh, MD
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1109-x

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