Prognostic Factors of Primary Small Bowel Adenocarcinoma: Univariate and Multivariate Analysis

Small-bowel tumors in the elderly 65+ years: 10 years of experience

Primary, secondary, benign or malignant tumorous diseases of the small intestine are rare. They are very often diagnosed by accident or as a cause of acute abdomen. Less serious symptoms can be overseen mainly in older patients. This work represents a prospective evaluation of a diagnostic and therapeutic algorithm in the management of the small-intestine tumor below the ligamentum Treitzi in patients over 65 years of age.

RESULTS

A population of 96 patients who underwent surgery for a small-intestinal tumor in our hospital from 1996 to 2006 is presented. Thirty-four of these patients were older than 65 years. Ultrasound of the small intestine was sufficient to make the diagnosis in 21 of them. Elective surgery (laparoscopy was highly preferred) could be offered to 31 of these older patients. Perioperative mortality was zero.

CONCLUSION

The small-bowel ultrasound can be recommended as the first choice method. All complaints regarding the gastrointestinal tract should be verified. Older patients can be safely offered an elective laparoscopic surgery with acceptable morbidity and mortality.

Clinical analysis of primary anaplastic carcinoma of the small intestine

Primary anaplastic carcinoma is a rare variant of small intestinal cancer. Most reports of primary anaplastic carcinoma of the small intestine are isolated case reports, therefore the clinicopathological features, therapeutic management, and surgical outcome of this tumor type remain unclear. This review analyzes the available clinical characteristics of primary anaplastic carcinoma of the small intestine and investigates key differences from differentiated adenocarcinoma of the small intestine. A Medline search was performed using the keywords ‘small intestine’ and ‘anaplastic carcinoma’ or ‘undifferentiated carcinoma’. Additional articles were obtained from references within the papers identified by the Medline search. The literature revealed a poor prognosis for patients who underwent surgical resection for anaplastic carcinoma of the small intestine, which gave a 3-year overall survival rate of 10.8% and a median survival time of 5.0 mo. The literature suggests that anaplastic carcinoma is markedly more aggressive than differentiated adenocarcinoma of the small intestine. Surgical resection with the aim of complete tumor removal provides the only beneficial therapeutic option for patients with anaplastic carcinoma of the small intestine, because chemotherapy and radiation therapy have no significant effect on the rate of survival. However, despite complete tumor resection, most patients with anaplastic carcinoma of the small intestine are at great risk of disease recurrence. Multicenter clinical trials are expected to provide additional therapeutic strategies and establish the efficacy of multimodality adjuvant therapy. This report also highlights the importance of a systematic diagnostic approach for anaplastic carcinoma of the small intestine.

[Lymphadenectomy with tumors of the lower gastrointestinal tract]

For advanced adenocarcinomas, which are the most frequent tumours of the lower GI tract, the concept of radical lymphnode dissection is well accepted. The quality of lymphadenectomy for these malignancies has a strong effect on cancer-related survival. Based upon a strict quality control program with outcome evaluated according to internal results, the technique and extent of lymph node dissection have been continuously developed over the last three decades. These are described in detail, including instructive pictures to clarify the surgical steps needed. Apart from multivisceral resection in far advanced cases, which still have a chance of cure if adequate guidelines are followed, two additional steps in the so-called radical surgical treatment of these tumours are prerequisites for cure. The first is complete mobilisation of the intestine involving complete mesocolic excision with complete retention of the visceral fascia and covering potential lymph node metastases and extranodal spread on the intestinal side. The second step is the central tying of the tumor's supplying vessels. Following these rules and with no adjuvant systemic treatment, 5-year survival figures of 80% can be reached, even for UICC stage III disease.