Primary small bowel adenocarcinoma

Abstract

IntroductionPrimary small bowel adenocarcinoma is an uncommon tumour, with nonspecific symptoms that cause a delay in the diagnosis and consequently a worse outcome for the patient. We analyse our experience in the management of this disease. Material and methodWe performed a retrospective study of our experience with 17 patients diagnosed with primary small bowel adenocarcinoma, excluding all the cases suggesting secondary involvement of the small bowel from an adenocarcinoma in other locations. ResultsWe analysed 9 females (53%) and 8 males (47%) with a mean age of 61.8 years. Tumour location was duodenum (8 cases), jejunum (5), and ileum (4). Those with duodenal tumours underwent 4 pancreaticoduodenectomies, 3 gastroenterostomies, and 1 diagnostic biopsy; 6 bowel resections with lymphadenectomy, 2 en-bloc resections, and 1 by-pass were performed on those with jejuno-ileal tumours. There were complications in 3 patients (18%). General survival was 18 months; in duodenal and jejunal tumours it was 15 months versus 58 in ileal ones (P=.048). Survival was 48 months in the absence of lymph node metastases versus 11 in those with (P=.067). In those tumours infiltrating the retroperitoneum, survival was 15 months compared to 23 when not affected (P=.09). ConclusionsCurative treatment consists of small bowel resection. Retroperitoneal infiltration was a non-resectability criterion in our series. Ileal location is associated with a better outcome. Advanced stages, lymph node metastases, non-resected cases, and retroperitoneal infiltration tended to be associated with a poor prognosis in our group.