Silja Dogg Helgadottir

Karin Ulrika Johansen

Kristin Huld Haraldsdottir

Abstract

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

		Duodenum	Small bowel*		Total
		(n=17)	(n=8)		(n=25)
	Anemia
	Yes	11 (64.7%)	2 (25.0%)		13 (52.0%)
	No	4 (23.5%)	6 (75.0%)		10 (40.0%)
	Missing data	2 (11.8%)	0 (0%)		2 (8.0%)
	Ileus
	Yes	0 (0%)	5 (62.5%)		5 (20%)
	No	17 (100%)	3 (37.5%)		20 (80.0%)
	Weight loss
	Yes	7 (41%)	5 (62.5%)		12(48.0%)
	No	8 (47.1%)	1 (12.5%)		9 (36.0%)
	Missing data	2 (11.8%)	2 (25.0%)		4 (16.0%)
	* Distal to the duodenum

Table II

	2002-2011		2012-2021
	Duodenum (n=9)	Small bowel*(n=5)	Duodenum (n=8)	Small bowel*(n=3)	Total (n=25)
Complications Clavien Dindo
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
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
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 ár
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 <5ár
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
**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)
ϯ6 died because of recurrent disease