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Surgical Management and Outcome in Primary Adenocarcinoma of the Small Bowel

¹ Department of Surgical Oncology, Roswell Park Cancer Institute, State University of New York, Elm and Carlton Streets, Buffalo, New York14263
² Department of Biostatistics, Roswell Park Cancer Institute, State University of New York, Buffalo, New York

Correspondence: Address correspondence and reprint requests to: Ashwani Rajput, MD; E-mail: ashwani.rajput{at}roswellpark.org

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.

Key Words: Small bowel • Adenocarcinoma • Prognosis

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