DOI: http://dx.doi.org/10.18203/2349-2902.isj20204681

Clinical outcome after surgical resection of small bowel cancer

Mohamed Mahmoud Ali, Ashraf Mohammad El-badry

Abstract


Background: Small bowel cancer (SBC) is rare, however there is recent trend toward increased incidence.

Methods: Retrospective evaluation of the clinical presentation, diagnosis, management and clinical outcome of adult patients with primary SBC who were admitted at Sohag University Hospital during 2014-2019.

Results: Twenty-one patients with SBC were enrolled (14 males and 7 females) with median age of 56 (range 32-83) years. Small bowel mass was identified preoperatively in 13 patients (62%). Thirteen patients (62%) presented with abdominal emergencies after failure of prompt diagnosis of non-specific abdominal pain of variable durations (median: 4, range: 2-11 weeks). Apart from duodenal tumors, histopathological diagnosis for jejunal and ileal tumors was not achieved preoperatively. Tumor types were gastrointestinal stromal tumors, GISTs (9, 43%), lymphoma (8, 38%) and adenocarcinoma (4, 19%). Patients with jejunal and ileal masses were managed by resection and primary anastomosis. Duodenal tumors required local resection in 2 and pancreatico-duodenectomy in 4 patients. Increased risk of aggressive behavior in GISTs, advanced stage and incomplete resection in lymphomas and adenocarcinomas were associated with higher recurrence rates and diminished survival. Follow-up ranged from 5 to 48 months, with survival rate of 76% (16 patients alive).

Conclusions: The diagnosis of SBC is difficult and delayed. Appropriate surgical management, even during emergency, could achieve prolonged survival.


Keywords


Small bowel cancer, GIST, Duodenal tumors

Full Text:

PDF

References


Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30.

Chen E, Vaccaro G. Small Bowel Adenocarcinoma. Clin Colon Rectal Surg. 2018;31(05):267-77.

Ko M-Y, Yen C-E, Yen H-H. Obscure gastrointestinal bleeding with negative abdominal computed tomography study: The importance of enteroscopy for early diagnosis of small bowel malignancy. JGH Open. 2020;4(1):94-6.

Barsouk A, Rawla P, Barsouk A, Thandra KC. Epidemiology of Cancers of the Small Intestine: Trends, Risk Factors, and Prevention. Med Sci. 2019;7(3).

Vivarelli S, Salemi R, Candido S, Falzone L, Santagati M, Stefani S, et al. Gut Microbiota and Cancer: From Pathogenesis to Therapy. Cancers. 2019;11(1).

Negoi I, Paun S, Hostiuc S, Stoica B, Tanasi I, Negoi RI, et al. Most small bowel cancers are revealed by a complication. Einstein São Paulo. 2015;13(4):500-5.

Li J, Wang Z, Liu N, Hao J, Xu X. Small bowel adenocarcinoma of the jejunum: a case report and literature review. World J Surg Oncol. 2016;14(1):177.

Bennett CM, Coleman HG, Veal PG, Cantwell MM, Lau CCL, Murray LJ. Lifestyle factors and small intestine adenocarcinoma risk: A systematic review and meta-analysis. Cancer Epidemiol. 2015;39(3):265-73.

Alves Junior AJT, Romero Machuca ME, Ribeiro RG, Garisto AM, de Oliveira LH, Banci SO, et al. Malignant Small Bowel Tumor - Case Series and Literature Review. Colorectal Cancer Open Access. 2018;04(1).

Rondonotti E, Koulaouzidis A, Yung DE, Reddy SN, Georgiou J, Pennazio M. Neoplastic Diseases of the Small Bowel. Gastrointest Endosc Clin N Am. 2017;27(1):93-112.

Bree E de, Rovers KP, Stamatiou D, Souglakos J, Michelakis D, Hingh IH de. The evolving management of small bowel adenocarcinoma. Acta Oncol. 2018;57(6):712-22.

Young JI, Mongoue-Tchokote S, Wieghard N, Mori MT, Vaccaro G, Sheppard B, et al. Treatment and Survival of Small-bowel Adenocarcinoma in the United States: A Comparison with Colon Cancer. Dis Colon Rectum. 2016;59(4):306-15.

Fletcher CDM, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol. 2002;33(5):459-65.

Zhang H, Liu Q. Prognostic indicators for gastrointestinal stromal tumors: a review. Transl Oncol. 2020;13(10).

Yildirim N, Turkeli M, Akdemir MN, Simsek M, Tekin SB. Evaluation of 22 Primary Gastrointestinal Lymphoma Patients. Eurasian J Med. 2019;51(1):53-6.

Taghipour Zahir S, Heidarymeybodi Z, AleSaeidi S. Prognostic Factors and Survival Time in Patients with Small Bowel Tumors: A Retrospective Observational Study. Int J Surg Oncol. 2019;1-6.

Farhat MH, Shamseddine AI, Barada KA. Small Bowel Tumors: Clinical Presentation, Prognosis, and Outcome in 33 Patients in a Tertiary Care Center. J Oncol. 2008:1-5.

Aparicio T, Zaanan A, Svrcek M, Laurent-Puig P, Carrere N, Manfredi S, et al. Small bowel adenocarcinoma: epidemiology, risk factors, diagnosis and treatment. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2014;46(2):97-104.

Gheorghe M, Predescu D, Iosif C, Ardeleanu C, Băcanu F, Constantinoiu S. Clinical and therapeutic considerations of GIST. J Med Life. 2014;7(2):139-49.

Lightner AL, Shannon E, Gibbons MM, Russell MM. Primary Gastrointestinal Non-Hodgkin’s Lymphoma of the Small and Large Intestines: A Systematic Review. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2016;20(4):827-39.

Hong Y-W, Kuo I-M, Liu Y-Y, Yeh T-S. The role of surgical management in primary small bowel lymphoma: A single-center experience. Eur J Surg Oncol EJSO. 2017;43(10):1886-93.

Xu J, Lu W, Shen Z, Ji F, Li Y, Zhang H. Diagnosis and treatment for primary small intestinal lymphoma of 59 cases: a follow-up study. Int J Colorectal Dis. 2016;31(7):1377-9.

Iida T, Nozawa H, Sonoda H, Toyama K, Kawai K, Hata K, et al. Upfront Surgery for Small Intestinal Non-Hodgkin’s Lymphoma. Anticancer Res. 2020;40(4):2373-7.

Chen J-S, Liu G, Li T-R, Chen J-Y, Xu Q-M, Guo Y-Z, et al. Pancreatic fistula after pancreaticoduo-denectomy: Risk factors and preventive strategies. 2019;15(4):857-63.