Primary Malignant Neoplasms of the Small Intestine: Histopathologic Determinants of Recurrenec and Survival

ABSTRACT

Primary malignant neoplasms of the small intestine account for only a small percentage of gastro intestinal tumors, but their prognosis is one of the worst. We reviewd the clinical features, diagnostic procedures, and outcome of surgical treatment in 29 patients with primary neoplasms of the small bowel in order to identify aspects of management that might be improved. A retrospective review of cases from 1981 to 1996 identified 29 patients with primary small intestinal tumors. Four histologic groups were identified adenocarcinoma, 11 patients; lymphoma, 10 patients; malignant stromal tumor, 7 patients; carcinoid, 1 patient. There were 20 men and 9 women. The mean age was 47.5 years(median age 51 years). The median follow-up was 19.1 months. Survival analysis was done by Kaplan-Meier methods. Preoperative diagnosis of a small intestinal tumor were rarely made because symtoms are vague and nonspecific, so preoperative diagnoses were made in only 11 of the 29 patients (37.9%). The median survival was 20.73 (+/-3.75) months for adenocarcinomas, 21.00 (+/-7.99) months for lymphomas, and 24.50 (+/-5.89) months for stromal tumors. Curative resection was achieved in 17 (58.6%) of the 29 patients, and the mean survival was significantly longer for this gruop (32.27 months vs 7.67 months, p<0.001). Of the 17 curative resections, the disease recurred in 8 patients (47.1%). Wide surgical resection of early lesions is the only potentially curative treatment, but it is possible in only a minority of patients.