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Treatment of small bowel neoplasms

James C Cusack, Jr, MD
Michael J Overman, MD
Hiroko Kunitake, MD
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD


A variety of tumors, both malignant and benign, arise within the small intestine. Malignant tumors include adenocarcinomas, carcinoids, sarcomas, and lymphomas, while benign lesions include adenomas, leiomyomas, lipomas, and hamartomas.

The treatment of the various types of neoplasms that arise in the small bowel will be reviewed here. The epidemiology, clinical manifestations, diagnosis, and staging of small bowel tumors are discussed separately. (See "Epidemiology, clinical features, and types of small bowel neoplasms" and "Diagnosis and staging of small bowel neoplasms".)


Locoregional disease

Surgery — Localized adenocarcinomas of the small bowel are best managed with wide segmental surgical resection. Resection of the primary and investing mesentery achieves surgical clearance of both the primary and the regional nodes at risk for metastases, and provides important staging information that impacts decisions regarding the need for adjuvant therapy (see below). However, resection of adequate mesentery may be limited by the proximity of the nodes or tumor to the superior mesenteric artery.

Pancreaticoduodenectomy is required for tumors involving the first and second portions of the duodenum. Some surgeons promote pancreaticoduodenectomy rather than wide local excision as a superior operation for all duodenal adenocarcinomas because of its more radical clearance of the tumor bed and regional lymph nodes [1,2]. However, this is not necessary for the following reasons:

Unlike pancreatic cancers, which diffusely infiltrate into the surrounding soft tissues, the extension of duodenal adenocarcinomas into adjacent tissues is usually a more localized process, and tumor-free resection margins may be obtained without resection of adjacent organs and soft tissues. Because a negative margin is critical to a curative procedure, the margin status of the resected specimen must be confirmed on frozen-section and subsequent permanent histologic sections [1,3,4].

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Literature review current through: Nov 2017. | This topic last updated: Sep 13, 2017.
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