title: Small bowel adenocarcinoma in Crohn's disease.
abstract: BACKGROUND
  An association between small bowel adenocarcinoma and Crohn's disease (CD) is well-established. We present our recent experience with this entity in order to further elucidate its clinicopathological features and update our series from 1991.
  
  
  METHODS
  A retrospective review was undertaken of all surgical patients with small bowel adenocarcinoma and CD seen at our institution between 1993 and 2009. Follow-up was assessed until time of death or by interview with survivors. Survival was calculated based on TNM (tumor extent, lymph node status, metastases staging) staging and comparing between our current and previous series.
  
  
  RESULTS
  Twenty-nine patients (ten females and 19 males) were identified and followed for a median of 2 years. The median age at onset of CD symptoms was 25, and the median age at cancer diagnosis was 55.4, for a mean interval of 25.3 years. Twenty-two cancers were ileal and five were jejunal. There were no cancers in excluded intestinal loops. Significant differences in 2-year survival were determined for: node-negative (79.3%, 95%CI 58.3-100%) versus node-positive cancers (49% %, 95%CI 20.0-78.0%), and for localized (92.3%, 95%CI 77.8-100%) versus metastatic disease (33.3%, 95%CI 6.6-60%). Overall 36-month survival was 69.3% (95%CI 51.5-87.1%) compared to 40% among those without excluded loops in our series from 1991. Sixteen patients had long periods of quiescent disease before diagnosis (7-45 years), and 16 required surgery for bowel obstruction that was refractory to medical management. Adequate information was not retrievable for three patients.
  
  
  CONCLUSIONS
  A comparison to our previous series reveals similar clinical characteristics and a high rate of node-positive cancer at diagnosis. Our findings also confirm two important clinical indicators of malignancy: recrudescent symptoms after long periods of relative quiescence and small bowel obstruction that is refractory to medical therapy.
authors.affiliation: Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Pl, P.O. Box 1259, New York, NY 10029, USA. Maria.Widmar@gmail.com
authors.forename: Maria
authors.initials: M
authors.lastname: Widmar
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Greenstein
authors.forename: David B
authors.initials: DB
authors.lastname: Sachar
authors.forename: Noam
authors.initials: N
authors.lastname: Harpaz
authors.forename: Joel J
authors.initials: JJ
authors.lastname: Bauer
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Greenstein
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D007580:Jejunal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult