Small bowel tumors: diagnosis, therapy and prognostic factors.
BACKGROUND
Tumors of the small bowel are rare, accounting for about 3-6% of all gastrointestinal neoplasms. However, diagnosis and treatment are difficult and an ongoing challenge.


METHODS
We retrospectively reviewed the medical records of 54 patients with tumors of the small intestine over a period of 10 years to elucidate important factors for diagnosis, therapy and prognosis.


RESULTS
42 patients had malignant (36 primary, 6 secondary) and 12 had benign tumors. Histologically, adenocarcinoma (33%), leiomyosarcoma (17%) and carcinoid (17%) were the most frequent malignancies found. All 12 benign lesions were either leiomyomas or adenomas. Initial symptoms were nonspecific: abdominal pain in 67% and 50%, anemia in 38% and 58% and weight loss in 38% and 42% in patients with malignant and benign tumors, respectively. Upper gastrointestinal series, endoscopy, computed tomography scan and selective angiography were the most useful diagnostic tools. Resectability rate for malignant tumors was 98%; curative resection was achieved in 51%. Survival for malignant tumors has been poor: median postoperative survival was 26.9 months, the 1- and 5-year survival rates were 42.9% and 20.8%, respectively.


CONCLUSIONS
These results document the need for an aggressive diagnostic work-up in these rare tumors with non-specific symptoms, as early diagnosis and radical operative therapy are important prognostic factors.
D015746:Abdominal Pain / Q000175:diagnosis; D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery; D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis; D000792:Angiography; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery; D007890:Leiomyosarcoma / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015431:Weight Loss