TREATMENT AND PROGNOSIS OF PRIMARY MALIGNANT SMALL-BOWEL TUMORS

Primary malignant tumors of the small bowel are a heterogeneous group of tumors and are uncommon compared to tumors in other locations of th e gastrointestinal tract. These tumors have been traditionally associa ted with a poor prognosis. The charts of 53 patients with primary mali gnant small bowel tumors at major Eastern Virginia Medical School teac hing hospitals were retrospectively reviewed. Patient characteristics and presenting symptoms and signs were nonspecific. No single radiogra phic or endoscopic procedure was performed on every patient, and the d iagnosis was suspected preoperatively in only 50 per cent of the patie nts. Tumors were most common in the ileum, and the most common histolo gic types were adenocarcinoma (53 per cent) and carcinoid (32 per cent ). In univariate analysis, factors determining survival included histo logic type, location of tumor, and stage. There was also a trend towar d worse survival in patients receiving chemotherapy or radiation thera py, possibly due to patient selection factors. In multivariate analysi s, only histology and stage significantly influenced survival. The ove rall 10-year survival of the entire group was 44 per cent. Small bowel tumors have a variable prognosis. A high index of suspicion and more frequent use of enteroclysis may lead to earlier detection and improve d survival.