Clinical features of and chemotherapy for cancer of the small intestine.
BACKGROUND
Cancer of the small intestine is a rare disease, and its clinical features have not been clearly elucidated. Techniques such as double balloon endoscopy and capsule endoscopy allow the preoperative diagnosis of cancer of the small intestine, but this cancer is often detected at an advanced state and in many cases postoperative chemotherapy is required. This study evaluated the pre- and postoperative clinical course of cancer of the small intestine and the effectiveness of chemotherapy.


METHODS
Patients who underwent surgery for cancer of the small intestine in this Department from July 1985 to December 2008 were included in this study. Duodenal cancer has vastly different origins, methods of diagnosis, and surgical procedures, so this form of cancer was excluded. There were 8 cases of jejunal or ileal cancer treated during the study period. The pre- and postoperative course of these cases was reviewed, as well as the effectiveness of chemotherapy in cases of recurrence.


RESULTS
The male:female ratio of the 8 patients was 6:2, the mean age at surgery was 59.7±15.9 (35-76) years, and the mean postoperative follow-up was 41.1±48.0 (7-152) months. Six patients underwent a partial resection of the small intestine, and a right hemicolectomy, and a bypass were performed in one case each. The tumor type according to Borrmann's classification indicated that 5 tumors were type 2, 2 were type 3, and 1 was type 5; the mean tumor size was 6.3±5.3 (2.5-18.0) cm. TNM staging indicated that 3 tumors were stage II, 1 was stage III, and 4 were stage IV. Six patients underwent postoperative chemotherapy. One patient underwent adjuvant chemotherapy of, and 5 patients with recurring or advanced cancer underwent therapeutic chemotherapy of. The course of chemotherapy for the 5 patients with recurrent or advanced cancer resulted in 4 patients with progressive disease (PD) and 1 with stable disease (SD). Three out of the four patients with PD died.


CONCLUSIONS
The basic treatment for cancer of the small intestine is surgical resection. Palliative surgery and chemotherapy are considered in cases where resection is not possible or the cancer recurs. Nevertheless, there is no established regimen for such chemotherapy. Cancer of the small intestine is currently being treated with chemotherapy based on the treatment strategies for colon cancer, but there are few reports of its success. Chemotherapy was unsuccessful in treating any of the patients with recurring or advanced cancer reviewed in this report. The diagnosis must therefore be improved and postoperative chemotherapy will be needed to treat cancer of the small intestine given its increasing incidence, and therefore physicians are working as quickly as possible to establish an optimal treatment regimen. Compiling and studying such cases are crucial to accomplishing that goal.
Higashi
Daijiro
D
Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikusino-shi, Fukuoka 818-8502, Japan. daijiro@fukuoka-u.ac.jp
Ishibashi
Yukiko
Y
Tamura
Tomoaki
T
Nii
Kaori
K
Egawa
Yuji
Y
Koga
Masakazu
M
Tomiyasu
Takashige
T
Harimura
Takanori
T
Tanaka
Ryosuke
R
Futatsuki
Ryo
R
Noda
Simpei
S
Futami
Kitaro
K
Maekawa
Takafumi
T
Takaki
Yasuhiro
Y
Hirai
Fumihito
F
Matsui
Toshiyuki
T
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged