Surgical Management and Outcome in Primary Adenocarcinoma of the Small Bowel

Abstract

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.

Prognostic value of lymph node evaluation in small bowel adenocarcinoma

“…To our knowledge, no prospective studies have been conducted, and no retrospective studies have demonstrated that the use of adjuvant chemotherapy lengthens overall survival or DSS. [30][31][32] In these retrospective series, selection bias may favor the use of adjuvant chemotherapy in patients at the greatest risk of disease recurrence, thus confounding the results. With a better understanding of the prognostic impact of lymph node assessment in patients who undergo curative resection, comparisons between populations with a more homogenous risk of recurrence can be conducted.…”

“…In particular, the primarily systemic pattern of recurrence and the proven activity of systemic chemotherapy in the metastatic setting continue to provide a strong rationale for further exploration of adjuvant chemotherapy in this rare cancer. 30,31,33 The effect that the subsite of the small bowel has on patient outcome is controversial. Consistent with our findings, data from the National Cancer Database have demonstrated worse outcomes for patients with duodenal adenocarcinoma than those with jejunal or ileal disease, although this correlation did not incorporate the stage of disease.…”

“…17 Several other small, single-institution studies have not reported a difference in survival dependent on a subsite within the small bowel. 9,30,31 Whether a difference in outcome reflects a biologic distinction between tumors of the duodenum compared with tumors of the jejunum and ileum is not known. In the current analysis, after adjusting for covariates, the duodenal site was a poor prognostic factor.…”

Jejunal Adenocarcinoma: An Elusive Diagnosis

“…However, the dissimilarities between two conditions end here and majority of the clinical conditions are similar in both, viz, abdominal pain (50-75%), nausea/vomiting (33-72.5%), weight loss (38-52.5%), intestinal obstruction (31.3-44%), and gastrointestinal bleeding (23-33%) in the descending order [12][13][14]. In addition to above, abdominal tuberculosis patients may also presents with history of pyrexia.…”

“…In jejunal adenocarcinoma the cancer directed surgery includes wide excision of jejunum along with mesentery and draining lymph nodes. This curative resection offers 50% chance of cure [13]. Chemotherapy does not seem to have significant effect on survival in most of the studies [14].…”