A single-center experience of small-bowel adenocarcinomas.

Abstract

337 Background: The age-adjusted incidence of small-bowel adenocarcinomas was reported as 1.9 per 100,000 per year (SEER 2003-2007). Even early-stage small bowel tumors are associated with a high risk of recurrence. We performed a retrospective chart review to analyze location, stage at presentation, and recurrence rate of early-stage small-bowel adenocarcinomas at our institution. Methods: Institutional (Ochsner Clinic) tumor registry database was used to identify patients with small-bowel adenocarcinoma from 1983 onward. Medical records were reviewed for pertinent patient information. Results: 44 patients (24 males, 20 females) were identified. 25 (56.8%) patients had a duodenal primary, 8 (18.1%) jejunal, 4 (9.0%) ileal, and 7 (15.9%) patients did not have a documented site of origin. Mean age at presentation was 64 yrs (range 31-84 yrs). The most common presenting symptoms were abdominal pain (40%), melena (25%), and small-bowel obstruction (16%). Histological grade II or III accounted for 64% of all tumors. Almost half of the patients (43.2%) presented with stage IV disease, which was associated with a median survival of 11.5 months. All patients staged as I, II, and III had a curative resection including 33% who underwent a Whipple's surgery. Four patients were not seen in follow-up at our institution and 6 patients died in the postoperative period from various complications. No stage I patient received adjuvant chemotherapy. All available stage II and III patients received adjuvant 5-FU based chemotherapy. The chemotherapy received was as follows: Stage II (two 5-FU, two FOLFOX); Stage III (four 5-FU, one capecitabine/irinotecan, one FOLFOX). The recurrence for each stage is shown in the Table. Conclusions: Although our numbers are small, stage I adenocarcinomas of the small bowel had a significant risk of recurrence. This warrants a multi institutional review of patient data to better quantify the risk of recurrence for this rare tumor and the implications for treatment trials. [Table: see text] No significant financial relationships to disclose.