P-0149 Small Bowel Adenocarcinoma: A Single Center Experience

Abstract

ABSTRACT Introduction Small bowel adenocarcinoma is a rare cancer with limited data available to guide its diagnosis and treatment. Methods The records of 20 patients hospitalized between 1990 and 2010 at the Centre Hospitalier Universitaire de Sherbrooke for small bowel adenocarcinoma were retrospectively reviewed for clinical and follow-up data, including epidemiologic and tumor characteristics, cancer treatment history (surgery and chemotherapy) and survival. To study exclusively primary small bowel adenocarcinoma, cases with any known history of adenocarcinoma in other organs were excluded. Tumors arising from the ampullary region were also excluded. Results 20 patients were included in the study. The median age at diagnosis was 65 years, 60% were female. Tumors were located in the duodenum (35%), jejunum (40%), and ileum (30%). The majority (60%) of tumors were moderately differentiated while 15% were poorly differentiated. Most tumors were metastatic at diagnostic (Stage 4: 64.7%). The most common presenting symptom was abdominal pain (65%) while 55% had small bowel obstruction and 55% had anemia at the time of diagnosis. The median duration of symptoms prior to diagnostic was 47 days. A noteworthy proportion of patient had predisposing conditions: 15% suffer from Crohn's disease and 10% from celiac disease. Interestingly, 8 patients display adenoma at the tumor site suggesting an adenoma-carcinoma sequence (40%). The median overall survival was 33 months, with a 5-year overall survival of 40%. The median overall survival was significantly shorter for stage 4 (24 days) than for stage 1-3 (105 days) (p=0.026). Predictors of poor survival were: age (p= 0.055), tumor stage (p=0.026) and resectability (p=0.004). Eight patients received adjuvant chemotherapy and the commonly used regimen was based on 5FU. The median interval between surgery and chemotherapy was 58 days. Of note, adjuvant therapy did not influence overall survival (p=0.079). Conclusion Small bowel adenocarcinoma remains a rare digestive cancer, diagnosed at advanced stage. The only curative treatment is surgical resection and the role of adjuvant chemotherapy is still controversial.