Prognostic factors in primary adenocarcinoma of the small intestine: 13-year single institution experience

Abstract

Background: Adenocarcinoma of the small bowel is a relatively rare malignancy as compared to the other malignancies of the gastrointestinal tract. Nonspecific presentation and infrequent occurrence often leads to a delay in diagnosis and consequent poor prognosis. Various other factors are of prognostic importance while managing these tumors.

Methods: The medical records of a total of 27 patients treated for adenocarcinoma of the small bowel at Providence Hospital and Medical Centers from year 1990 through 2003 were reviewed retrospectively. Data were analyzed using SPSS software (version 10.0; SPSS, Inc., Chicago, IL). Survival analyses were calculated using the Kaplan Meier method with the log rank test to assess the statistical significance. The socio-demographics (age, gender) were calculated using frequency analyses.

Results: The patients included nine males and eighteen females with a median age at diagnosis of 62 years. Only 48% of the patients had an accurate preoperative diagnosis while another 33% had a diagnosis suspicious of small bowel malignancy. None of the patients presented in stage 1. The cumulative five-year survival was 30% while the median survival was 3.3 years. There was no 30-day mortality in the postoperative period in our series.

Conclusion: The univariate analysis demonstrated that tumor grade, stage at presentation, lymph nodal metastasis and resection margins were significant predictors of survival.

Figure 1

Overall Survival.

Figure 2

Survival by Lymph Node Involvement.

Figure 3

Survival by Resection Procedure.

Figure 4

Survival by Margin Involvement*. 3 patients had unresectable tumors, and, therefore, have been excluded from this analysis.

Figure 5

Survival by Stage.

Figure 6

Survival by Vascular Involvement*. One out of 27 patients did not have data on vascular invasion in the histopathological report.