Small Bowel Tumors – Case Series Analysis: Prognostic Factors and Survivals

Small intestinal malignancy is uncommon. The clinical characteristics vary with histologic subtype, and factors predictive of outcome are not well studied. A case series analysis of clinicopathologic data from patients undergoing small intestinal malignancy resection in our institution was used over a 6-year period. Kaplan Meier survival estimates were compared using Log-rank and survival curves constructed. Multivariate analysis enabled determination of factors predictive of outcome. Eighty-seven patients were included; 24 required emergency surgery and neuroendocrine (NET) was the most common histological subtype. NETs were significantly smaller than adenocarcinomas or gastrointestinal stromal tumors (GISTs); however, a greater proportion of NETS had metastatic disease, perineural invasion and underwent R1 resection. Despite their advanced stage at presentation, NETs demonstrated favorable outcome compared with other histologic subtypes. Tumor grade, neuroendocrine histology and nodal metastasis were all independently associated with overall survival. Despite the advanced stage of NETs at presentation, these tumors demonstrated better overall survival than adenocarcinomas or GISTs. De-bulking with R1 resection is an acceptable approach for NET as compared to adenocarcinoma or GIST. Future work needs to focus on the development of targeted therapies for small intestinal adenocarcinoma to improve long-term outcome.