Primary small bowel malignant tumors

We reviewed 69 patients who underwent surgery for primary malignant tumors of the small bowel over a 15-year period. Patients with periampullary lesions were excluded, as were those with known adenocarcinomas in other sites. There were 46 males (67%) and 23 females (33%) with an average age at presentation of 52.6 years (range 4-92). Of the 69 patients, four (6%) were asymptomatic. The mean duration of symptoms before diagnosis, in the remaining 65 symptomatic patients, was 3.6 months (range 1 day 1.2 years). The most frequent symptom was abdominal pain (83%), followed by nausea and/or vomiting (54%), and weight loss (43%). Abdominal mass was the most common finding on physical examination (29%), followed by abdominal distension (24%) and abdominal guarding and rigidity (14%). Laboratory examinations were normal in 26 patients (40%). Radiographic study of the duodenum and small bowel was abnormal in 87%. The diagnosis was suspected preoperatively in 51%. Lymphoma was the most common tumor (42%), followed by adenocarcinoma (38%), carcinoid (10%) and leyomiosarcomas (10%). In 41% the neoplasm was located in the jejunum, in 33% in the ileum, in 22% in the duodenum and in 4% multiple sites were found. Lymph node metastases were found in 45% and vascular invasion was found in 19%. Of the 65 symptomatic patients 43% presented as surgical emergencies, the rest had elective surgery. 61% had a curative resection, the rest were palliative or a bypass. The operative mortality rate was 10% and the morbidity rate was 24%. Ten patients underwent emergency surgery, developed a complication, giving a morbidity rate of 32% in this group. The 5-year overall survival was 43.25%. The 5-year survival for carcinoid tumors was 60% while the 5-year survival for small bowel malignant lymphoma and adenocarcinoma was 40 and 34.28% respectively.