title: Surgical management and outcome in primary adenocarcinoma of the small bowel.
abstract: BACKGROUND
  Primary adenocarcinoma of the small bowel is a rare malignancy and is associated with poor survival outcome. Patient, tumor and treatment-related factors were analyzed for their association with recurrence and survival.
  
  
  METHODS
  Between 1971 and 2005, 64 patients with primary adenocarcinoma of the small bowel were treated at our institution. Clinico-pathologic data, operative details, postoperative treatment, recurrence pattern and survival were reviewed.
  
  
  RESULTS
  The most common clinical features at presentation included abdominal pain (n = 33; 51.6%) or bowel obstruction (n = 20; 31.3%). The most frequently involved portion of the small bowel was the duodenum (n = 41; 64%). A segmental bowel resection was performed in 30 patients and pancreaticoduodenectomy in 14 patients. Postoperative mortality and morbidity rates were 3.6% (n = 2) and 14.5% (n = 8), respectively. Of the 55 patients who underwent operative intervention, a curative resection was performed in 30 (54.5%). The most common sites of recurrence following a curative resection were the liver and lung. Median survival for all 64 patients was 18 months with a 5-year survival of 21.1%. On multivariate analysis, absence of distant metastatic disease (5-year survival 30.4%), curative resection (5-year survival 44.8%) and pathological T stage 1-3 (5-year survival 39.2%) were identified as independent predictors of survival.
  
  
  CONCLUSIONS
  A curative resection in the absence of both distant metastases and pathological T4 tumor provides the best survival outcome. Recurrence at distant sites is the predominant pattern of failure following a curative resection, suggesting a role for adjuvant therapy.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, State University of New York, Elm and Carlton Streets, Buffalo, New York 14263, USA.
authors.forename: Shefali
authors.initials: S
authors.lastname: Agrawal
authors.forename: Edward C
authors.initials: EC
authors.lastname: McCarron
authors.forename: John F
authors.initials: JF
authors.lastname: Gibbs
authors.forename: Hector R
authors.initials: HR
authors.lastname: Nava
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Wilding
authors.forename: Ashwani
authors.initials: A
authors.lastname: Rajput
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome