Diagnosis, treatment and prognosis of patients with small bowel adenocarcinoma in Landspítali University Hospital 2002-2021
Background: Small intestine adenocarcinoma is a rare cancer with poor prognosis. The only curative treatment is surgery to remove the tumor. If the tumor is located in the duodenum, a pancreaticoduodenectomy is recommended, while partial resection of the small intestine is advised for tumors located more distally.
Materials and methods: Data was obtained from the medical records system at Landspítali. Variables were recorded in Excel, and descriptive statistics along with survival calculations were performed using the statistical software R.
Results: A total of 47 patients were diagnosed with small intestine adenocarcinoma, 32 in the duodenum and 15 more distally. Curative surgery was performed on 25 patients. Severe complications (≥3 on the Clavien-Dindo scale) occurred in 32% of cases. The recurrence rate was 24%. One-year survival for patients undergoing surgery was 80%, while five-year survival rate was 56%. Five-year survival was higher for tumors originating in the duodenum (70,6%) compared to other parts of the small intestine (25,0% p>0,05).
Conclusion: Small intestine adenocarcinoma is a rare condition, with few patients diagnosed during the study period. A high proportion of patients underwent surgery, but one out of every four was diagnosed with recurrence during follow-up. No previous results for small intestine cancer in Iceland have been published, making comparisons with other countries difficult due to the low incidence of this cancer.
Table I
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| Duodenum | Small bowel* |
| Total |
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| (n=17) | (n=8) |
| (n=25) |
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| Anemia |
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| Yes | 11 (64.7%) | 2 (25.0%) |
| 13 (52.0%) |
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| No | 4 (23.5%) | 6 (75.0%) |
| 10 (40.0%) |
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| Missing data | 2 (11.8%) | 0 (0%) |
| 2 (8.0%) |
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| Ileus |
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| Yes | 0 (0%) | 5 (62.5%) |
| 5 (20%) |
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| No | 17 (100%) | 3 (37.5%) |
| 20 (80.0%) |
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| Weight loss |
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| Yes | 7 (41%) | 5 (62.5%) |
| 12(48.0%) |
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| No | 8 (47.1%) | 1 (12.5%) |
| 9 (36.0%) |
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| Missing data | 2 (11.8%) | 2 (25.0%) |
| 4 (16.0%) |
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| * Distal to the duodenum |
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Table II
| 2002-2011 |
| 2012-2021 |
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| Duodenum (n=9) | Small bowel*(n=5) | Duodenum (n=8) | Small bowel*(n=3) | Total (n=25) |
Complications Clavien Dindo |
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3a-4b** | 2 (22.2%) | 0 (0%) | 3 (37.5%) | 0 (0%) | 5 (20.0%) |
5*** | 1 (11.1%) | 1 (20.0%) | 0 (0%) | 0 (0%) | 3 (12.0%) |
Alive >1 year |
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Yes | 6 (66.7%) | 4 (80%) | 7 (87.5%) | 3 (100%) | 20 (80%) |
No | 3 (33.3%) | 1 (20.0%) | 1 (12.5%) | 0 (0%) | 5 (20%) |
Alive >5 years |
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Yes | 5 (55.5%) | 2 (40.0%) | 7 (87%) | 0 (0%) | 14 (56.0%) |
No | 4 (44.4%) | 3 (60.0%) | 1 (12.5%) | 3 (100%) | 11ϯ(44.0%) |
Recurrence <1 year |
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Yes | 1 (11.1%) | 2 (40.0%) | 0 (0%) | 1 (33.3%) | 4 (16%) |
No | 8 (88.9%) | 3 (60.0%) | 8 (100%) | 2 (66.7%) | 21 (84.0%) |
Recurrence <5year |
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Yes | 1 (11.1%) | 2 (40.0%) | 0 (0%) | 3 (100%) | 6 (24.0%) |
No | 8 (88.9%) | 3 (60%) | 8 (100%) | 0 (0%) | 19 (76.0%) |
| Not discussed in MDT (n=17) | Discussed in MDT (n=7) | Not discussed in MDT (n=3) | Discussed in MDT (n=20) | Total (n=47) |
Operation | 8 (47%) | 6 (86%) | 0 (0%) | 11 (55%) | 25 (53%) |
Not operated | 9 (53%) | 1 (14%) | 3 (100%) | 9(45%) | 22 (47%) |
*Small bowel distal to the duodenum |
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**3a invasive treatment done in local anesthetic, 3b invasive treatment done under general anesthesia, 4a organic failure, single system failure, 4b multiorgan failure | |||||
***Mortality (<30 days) |
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ϯ6 died because of recurrent disease |
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