Small bowel tumors: diagnosis, therapy and prognostic factors

Background. Tumors of the small bowel are rare, accounting for about 3-6% o f all gastrointestinal neoplasms. However, diagnosis and treatment are diff icult and an ongoing challenge. Methods: We retrospectively reviewed the me dical records of 54 patients with tumors of the small intestine over a peri od of 10 years to elucidate important factors for diagnosis, therapy and pr ognosis. Results: 42 patients had malignant (36 primary, 6 secondary) and 1 2 had benign tumors. Histologically, adenocarcinoma (33%), leiomyosarcoma ( 17%) and carcinoid (17%) were the most frequent malignancies found. All 12 benign lesions were either leiomyomas or adenomas. Initial symptoms were no nspecific: abdominal pain in 67% and 50%, anemia in 38% and 58% and weight loss in 38% and 42% in patients with malignant and benign tumors, respectiv ely. Upper gastrointestinal series, endoscopy, computed tomography scan and selective angiography were the most useful diagnostic tools. Resectability rate for malignant tumors was 98%; curative resection was achieved in 51%. Survival for malignant tumors has been poor: median postoperative survival was 26.9 months, the 1- and 5-year survival rates were 42.9% and 20.8%, re spectively. Conclusions: These results document the need for an aggressive diagnostic work-up in these rare tumors with non-specific symptoms, as earl y diagnosis and radical operative therapy are important prognostic factors.