The evolving management of small bowel adenocarcinoma

Bree, Eelco de; Rovers, Koen P.; Stamatiou, Dimitris; Souglakos, John; Michelakis, Dimosthenis; Hingh, Ignace H. J. T. de

doi:10.1080/0284186x.2018.1433321

Cited by 34 publications

(39 citation statements)

References 105 publications

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“…It has been reported that adjuvant chemotherapy could significantly improve TNM stage III SBA patients compared to those receiving only surgical treatment [32] . The combination of a fluoropyrimidine and oxaliplatin appears to be the most effective systemic chemotherapy for disseminated disease [33] . However, the efficacy of adjuvant chemotherapy appear to have minimal impact in improving the prognosis of patients with TNM stage I and II disease [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…The combination of a fluoropyrimidine and oxaliplatin appears to be the most effective systemic chemotherapy for disseminated disease [33] . However, the efficacy of adjuvant chemotherapy appear to have minimal impact in improving the prognosis of patients with TNM stage I and II disease [ 32 , 33 ]. Furthermore, there is limited evidence to support the efficacy of radiotherapy and therefore, adjuvant radiotherapy is not recommended for patients with SBA [33] .…”

Section: Discussionmentioning

confidence: 99%

“…However, the efficacy of adjuvant chemotherapy appear to have minimal impact in improving the prognosis of patients with TNM stage I and II disease [ 32 , 33 ]. Furthermore, there is limited evidence to support the efficacy of radiotherapy and therefore, adjuvant radiotherapy is not recommended for patients with SBA [33] . For SBA patients with metastatic disease, systemic chemotherapy seems to show benefit, whereby the combination of a fluoropyrimidine and oxaliplatin (FOLFOX or CAPOX) appears to be the most effective front-line regimen [33] , [34] , [35] , [36] .…”

Section: Discussionmentioning

confidence: 99%

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Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study

Dai¹,

Wang²,

Zhang³

et al. 2020

EBioMedicine

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Background Log odds of positive lymph nodes (LODDS) classification showed superiority over 8 th edition N staging in predicting survival of small bowel adenocarcinoma (SBA) patients. The aim of this study was to develop and validate the Tumor, LODDS, and Metastasis (TLM) staging of SBA. Methods Totally 1789 SBA patients from the Surveillance, Epidemiology, and End Results (SEER) database between 1988–2010, 437 patients from SEER database between 2011–2013 and 166 patients from multicenters were categorized into development, validation and test cohort, respectively. The TLM staging was developed in the development cohort using Ensemble Algorithm for Clustering Cancer Data (EACCD) method. C-index was used to assess the performance of the TLM staging in predicting cancer-specific survival (CSS) and was compared with the traditional 8 th edition TNM staging. Findings Four-category TLM staging designed for the development cohort showed higher discriminatory power than TNM staging in predicting CSS in the development cohort (0.682 vs. 0.650, P < 0.001), validation cohort (0.682 vs. 0.654, P = 0.022), and test cohort (0.659 vs. 0.611, P = 0.023), respectively. TLM staging continued to show its higher predictive efficacy than the 8 th TNM in TNM stage II/III patients or in patients with lymph node yield less than 8. Interpretation TLM staging showed a better prognostic performance than the 8 th TNM staging especially TNM stage II/III or patients with lymph node yield less than 8 and therefore, could serve to complement the TNM staging in patients with SBA. Funding A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study

Dai¹,

Wang²,

Zhang³

et al. 2020

EBioMedicine

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“…Lymph node metastasis and distal small intestine location (jejunum and ileum) have been found to be the most important independent factors determining prognosis,9 with nodal metastasis being the main prognostic factor 10. While current SBA surgery guidelines require the removal of 8–10 regional lymph nodes to investigate for metastasis, as it correlates with improved prognosis,11 only a single lymph node was harvested from our patient’s excised tumour; considering that the exploratory laparotomy was performed urgently for small bowel obstruction (SBO)—with significant time spent on lysis of adhesions—rather than with the intention of a tumour resection or a suspicion for SBA, the recommended number of nodes was not removed. Nonetheless, improved 10-year survival is found in the well-differentiated and moderately differentiated compared with that of the undifferentiated subtype (43% vs 0%, respectively) 3.…”

Section: Discussionmentioning

confidence: 99%

Patient with Lynch syndrome with subsequent development of small bowel adenocarcinoma

Azizi¹,

Inam

Farrell

2018

BMJ Case Reports

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Small bowel adenocarcinoma (SBA) is a rare cancer in the general population, but the incidence increases in patients with Lynch syndrome. The present case describes a 57-year-old white woman with a history of colon cancer status posthemicolectomy and diagnosis of Lynch syndrome. Twenty years after her operation, the patient presented with vague abdominal discomfort and constipation, and underwent an exploratory laparotomy which revealed a stage 3A SBA. Genetic testing of the specimen provided evidence of microsatellite instability and faulty DNA repair supporting aetiology of Lynch syndrome. This case is unique in that SBA, if present in patients with Lynch syndrome, is usually a presenting symptom and has not been widely described in literature as an occurrence so many years after. As a result, this case highlights the importance of a low threshold for a thorough evaluation in patients with Lynch syndrome who present with signs of small bowel obstruction.

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“…The second duodenal portion is the site with the highest incidence of adenocarcinoma (74%), followed by the third (13%), fourth (9%) and first (4%) portions. Early lesions, confined to the mucosa and submucosa, can be managed by endoscopic mucosal or submucosal resection, but for an advanced disease, surgical resection represents the best approach ( 87 ).…”

Section: Malignant Tumorsmentioning

confidence: 99%

Impact of enteroscopy on diagnosis and management of small bowel tumors

Safatle‐Ribeiro

Ribeiro

2020

Chinese Journal of Cancer Research

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Small bowel tumors (SBTs) have been increasingly diagnosed in recent decades. The pathogenesis of this increment is largely unknown, but advances in radiological and endoscopic methods facilitate the improvement of the diagnosis. Capsule endoscopy (CE) and device-assisted enteroscopy (DAE) allow the clinician to assess the entire small bowel in the search for suspicious lesions, or a cause of symptoms. In this review, we discuss the role of enteroscopy, techniques and strategies in the diagnosis and management of SBTs, and a brief description of the most common tumors.

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The evolving management of small bowel adenocarcinoma

Abstract: SBA is a rare and unique malignancy, whose diagnostic approach and treatment are evolving, resulting in improved outcome.

Cited by 34 publications

References 105 publications

Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study

Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study

Patient with Lynch syndrome with subsequent development of small bowel adenocarcinoma

Impact of enteroscopy on diagnosis and management of small bowel tumors

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