Search

Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains the standard of treatment in advanced disease. Recently immunotherapy has demonstrated to be a valid therapeutic option for many solid tumors. We reviewed the data published in literature to understand the impact of immunotherapy in this cancer. [ABSTRACT FROM AUTHOR]

• Adenocarcinoma of jejunum is a very rare malignant tumor worldwide. • Small intestine cancer is difficult to diagnose histologically before surgery, and whether it is diagnosed before surgery has an important influence on the surgical method. • Multidisciplinary treatment was conducted to diagnose small intestine cancer and determine treatment options, which is a global trend. • In this case, the preoperative balloon endoscopy was used to diagnose small intestine cancer histologically, as well as the location of the lesion, so that the operation could be performed by laparoscopy. We report a rare case of a patient diagnosed with adenocarcinoma of the jejunum. The patient was a 58-year-old female patient who was tested for vomiting and dyspeptic symptoms at a local hospital and visited the hospital due to suspected small bowel obstruction. CT enteroscopy performed at our clinic revealed "progression of focal wall thickening in small bowel with proximal bowel dilatation", and it was necessary to differentiate between malignant and infectious lesions. Balloon enteroscopy was planned for endoscopic observation up to the small bowel. The biopsy result was confirmed as adenocarcinoma with moderated differentiated. The patient underwent small bowel resection and anastomosis using standard laparoscopic surgery. Jejunum resection was performed by securing a safety margin of 10 cm or more, and sufficient LN dissection was also performed. The patient was discharged from the hospital without any specific complications, and as a result of pathology examination, it was confirmed as a stage 2 high risk group, and further treatment is in progress. There are few reports of patients diagnosed with adenocarcinoma of the jejunum through symptoms of obstruction of the small intestine. We report on a case of laparoscopic surgery for a rare jejunal cancer confirmed histologically before surgery. [ABSTRACT FROM AUTHOR]

• Laparoscopic duodenojejunostomy is a common intervention for the stricture of the distal duodenum. • Not all patients respond to this intervention, and methods to treat them must be discussed. • Opioid-induced bowel dysfunction caused fluids to accumulate in the jejunal loop in our case. • Jejunojejunostomy was a solution to treat our patient. Laparoscopic duodenojejunostomy is a common surgical treatment for SMA syndrome. Although there are successful cases of laparoscopic duodenojejunostomies on malignant conditions, cancer patients with opioid-induced bowel dysfunction could struggle in maintaining an oral diet despite surgical treatment of the mechanical obstruction. A 66 year-old woman with a chemotherapy history of 18 months for Stage 4 jejunal cancer near the ligament of Treiz presented with vomiting and dehydration. She had a gastrojejunostomy constructed prior to the induction of chemotherapy. CT scan and endoscopic studies confirmed the stricture of this anastomosis due to tumor invasion. Laparoscopic duodenojejunostomy was performed, but tolerable food intake was not achieved, likely due to limited bowel movements caused by opioid use and tumor invasion of the celiac plexus. A side-to-side jejunojejunostomy was constructed, since accumulation of food in her jejunal loop was thought to be a significant cause of her limited food intake and vomiting. She was able to tolerate oral intake after the second intervention and was discharged home. Successful cases of laparoscopic duodenojejunostomy in malignant strictures of the duodenum have been reported. In this case, the outcome was not so well due to limited bowel movements caused by opioid use. Literature review of laparoscopic duodenojejunostomy on SMA syndrome revealed some cases to be unsuccessful in enabling oral feeding or resolving nausea, and methods to treat such cases could be discussed further. Laparoscopic duodenojejunostomy is an option for malignant strictures of the duodenum, but a favorable outcome could not be achieved in our case. A side to side anastomosis of the jejunal loop and the efferent jejunum may help in improving the outcome. [ABSTRACT FROM AUTHOR]

An 84-year-old male was admitted to a local clinic suffering from general fatigue with associated anemia, and therefore was referred to our hospital. His medical history included a proximal gastrectomy with the formation of a jejunal pouch as a reconstructive treatment for early upper gastric cancer at 78 years of age (6 years prior). A type 2 tumor located in the jejunal pouch almost completely surrounded by small intestinal mucosa was demonstrated by gastrointestinal endoscopy. The biopsy specimens showed a moderately differentiated tubular adenocarcinoma. Computed tomography showed no lymphadenopathy or hepatic metastases. A resection of the residual stomach and jejunal pouch was performed. Based on the histological findings from the resected specimen, the tumor was considered to be primary adenocarcinoma in the jejunal pouch. The postoperative course was uneventful, and the patient has shown no evidence of any recurrence during the 6-year period after the most recent surgery. [ABSTRACT FROM AUTHOR]

50-year-old woman was admitted to our hospital because of abdominal distension and fullness. Computed tomography and magnetic resonance imaging showed bilateral ovarian tumors. Although these ovarian tumors were suspected of being metastatic, the primary tumor site could not be detected before the bilateral salpingo-oophorectomy. At the time of laparotomy, there was no apparent peritoneal dissemination or ascites. The pathological findings suggested that the ovarian tumors were metastases from cancer of the digestive tract. Positron emission tomography using F-fluorodeoxyglucose positron emission tomography (FDG-PET) and double-balloon enteroscopy detected jejunal cancer. A second laparotomy for the resection of jejunal cancer was performed. The patient received adjuvant chemotherapy, and there has not been any recurrence for 24 months since the resection was performed. In conclusion, FDG-PET was found to play a valuable role in the detection of the primary tumor. Intensive chemotherapy and surgical treatment also contributed to the long-term survival of the patient. [ABSTRACT FROM AUTHOR]

Background: Small bowel cancers are rare gastrointestinal malignancies and tumor location impact on outcomes is unclear., Material and Methods: A retrospective review was performed on stage I to IV small bowel cancer cases from 2000 to 2017 in British Columbia, Canada. Baseline patient characteristics, disease-free survival (DFS) and overall survival (OS) were evaluated by tumor location and systemic therapy use patterns were summarized., Results: Of 340 patients included, primary tumor distribution was: duodenum (51.2%), ileum (19.1%), jejunum (18.5%), and unspecified (11.2%). Median DFS for stage I to III disease was 37.7, 49.1, and 26.7 months for duodenal, jejunal, and ileal tumors (P = .018). Median OS was 9.6, 35.2, and 20.1 months for duodenal, jejunal, and ileal tumors (P < .0001). Compared to duodenal primaries, both jejunal and ileal tumors were associated with significantly improved OS (HR 0.43, P < .001 for jejunal; HR 0.71, P = .035 for ileal). Adjuvant therapy was given to 21.6% of stage II and 50.6% of stage III cancers. Among patients with metastatic disease, median OS was 4.2, 11.4, and 6.9 months for duodenal, jejunal, and ileal tumors (P = .0019). Jejunal tumors had the best prognosis (HR 0.48, P = .001 vs. duodenum)., Conclusion: Survival differences exist when small bowel cancers were assessed by tumor location, and jejunal tumors portended better prognosis overall., (Copyright © 2021. Published by Elsevier Inc.)