Clinical study of small bowel adenocarcinoma with surgical intervention

Abstract

Objective: Small bowel adenocarcinoma (SBA) is a rare disease but its clinical features have been clearly elucidated. The present study clarified the clinicopathological characteristics, the effectiveness of the surgical procedure, neoadjuvant chemotherapy, and adjuvant chemotherapy of the patients with SBA. Patients and Methods: The clinicopathological characteristics of 9 cases of SBA resected at our hospital were reviewed between 2004 and 2017. Results: The mean age of the 9 patients (4 men, 5 women) was 69.6 (57-83) years. The sites included the duodenum (n=3), jejunum (n=3), and ileum (n=3). As neoadjuvant chemotherapy, S-1 was administered to a patient with a large duodenal adenocarcinoma invading the portal vein. The surgical procedures included partial resection of jejunum (n=3); partial resection of ileum (n=3); pylorus-preserved pancreatoduodenectomy (PD) (PPPD) with right hemicolectomy due to invasion of ascending colon (n=1); subtotal stomach-preserving PD (SSPPD) (n=1); and wedge resection of the duodenum (n=1). The stage was classified as follows: stage I (n=1), stage IIA (n=1), stage IIB (n=3), stage IIIA (n=1), stage IIIB (n=2), and unknown, (n=1). As adjuvant chemotherapy, S-1 was administered to three stage IIB patients, one IIIA patient, and one IIIB patient. Tegafur uracil (UFT) + calcium folinate (LV) was administered to one stage IIIB patient. The cumulative five-year survival rate was 77.8%. Conclusions: Aggressive esophagogastroduodenoscopy, double-balloon endoscopy, and colonoscopy for symptoms such as anemia and abdominal pain, as well as intraoperative during abdominal surgery, would improve the prognosis of SBA.

Keywords

• small bowel adenocarcinoma
• diagnosis
• surgical procedure
• neoadjuvant chemotherapy
• adjuvant chemotherapy