MALIGNANT SMALL-BOWEL NEOPLASMS - HISTOPATHOLOGIC DETERMINANTS OF RECURRENCE AND SURVIVAL

Introduction Small bowel neoplasms account for only a small percentage of gastrointestinal tumors, but their prognosis is one of the worst. Purpose This study examines the histopathology, treatment, recurrence, and overall survival of a group of patients with primary small bowel tumors. Methods From 1970 to 1991, a retrospective review identified 7 3 patients with primary small bowel tumors. Four histologic groups wer e identified: 1) group 1, adenocarcinoma, 29 patients; group 2, lympho ma, 18 patients; group 3, sarcoma, 8 patients; and group 4, carcinoid, 18 patients. There were 44 men and 29 women. The median age was 57 ye ars (range, 26 to 90). Median follow-up was 15 months. Survival analys is was by the Mantel-Cox and Breslow methods. Results The most common, by type, was group 1, duodenum; group 2, jejunum; group 3, jejunum; a nd group 4, ileum. The preoperative diagnosis was made in only 14 pati ents. The median survival for adenocarcinomas and lymphomas was 13 mon ths, 18 months for sarcomas, and 36 months for carcinoids. Curative re section could be achieved in 48 (65%) of 73 patients, and the median s urvival was significantly longer for this group (26 months vs. 11 mont hs, p < 0.05). Of the 48 curative resections, 20 patients (42%) recurr ed: group 1, 8/19 (42%); group 2, 4/12 (33%); group 3, 4/13 (31%); gro up 4, 4/4 (100%). The median time to recurrence was 17 months, and the median survival after recurrence was 20 months. Adjuvant chemotherapy -radiation therapy did not alter survival in any group. Conclusions Th e preoperative diagnosis of small bowel tumors rarely is made because symptoms are vague and nonspecific. Surgical resection for cure result s in improved survival. Recurrence is common and survival after recurr ence is poor. Other treatment methods have no role in the management o f these patients.