New aspects of prognostic factors in adenocarcinomas of the small bowel

Background/Aims: Primary small bowel tumors are rare and the prognosis is g enerally considered to be poor. Histologically chiefly adenocarcinomas are reported. The surgeon is challenged in their treatment, because of the infr equency, unspecific symptoms and delay in diagnosis. Retrospectively we inv estigated the surgical therapy, combined morbidity, survival rates and prog nostic factors in a large series of primary adenocarcinomas of the small bo wel at a single surgical center. Methodology: Between 1985 and 1998, 94 patients with a primary tumors of th e small bowel (malignant n=62 [65.9%], benign n=32 [34.1%]) were operated o n. The subgroup of the adenocarcinomas (n=22) were considered for this stud y. Results: The median follow-up is 8.4 years (range: 0.9-14.2 years). Sixteen patients had a follow-up more than 5 years. The main surgical procedure wa s a small bowel segment resection. Morbidity was 13.6% (only in patients wi th a duodenal tumors) and the 30-day mortality 5.6%. The estimated 2-year-s urvival rate was 66%, the 5-year-survival rate 45%. Univariate analysis ide ntified the presence of the residual tumor (R-status) (P=0.004), tumor stag e according to the UICC (P=0.01), lymph node metastasis (P=0.007), distant metastasis (P=0.001), lymphangiosis carcinomatosa (P=0.001) and vascular in vasion (P=0.0008) as prognostic factors. Conclusions: A complete macroscopic and microscopic tumor resection includi ng a systematic lymph node dissection has to be the aim of any curative sur gical approach in patients with adenocarcinoma of the small bowel.