Clinical Outcomes of Small Bowel Adenocarcinoma

Akce, Mehmet; Jiang, Renjian; Zakka, Katerina; Wu, Christina; Alese, Olatunji B.; Shaib, Walid Labib; Behera, Madhusmita; El‐Rayes, Bassel F.

doi:10.1016/j.clcc.2019.08.002

Cited by 25 publications

(31 citation statements)

References 27 publications

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“…Akce et al demonstrated that duodenal localization tends to have worse patients' survival than jejunal/ileal adenocarcinomas (1). In contrast, we found that patients with distal (jejunal/ileal) adenocarcinomas had significantly shorter OS times than those with proximal (duodenal) adenocarcinomas.…”

Section: Discussioncontrasting

confidence: 63%

“…Small intestinal adenocarcinoma is rare cancer that is clinically distinct from colorectal cancer but managed similarly due to the lack of prospective data necessary for establishing optimal management. However, recent studies demonstrated that the clinicopathologic and molecular features of small intestinal adenocarcinoma differed from those of colorectal cancer (1,2). The majority of small intestinal adenocarcinoma patients are diagnosed at an advanced disease stage because of a lack of early detection tools, low incidence, and nonspecific clinical symptoms (1,3).…”

Section: Introductionmentioning

confidence: 99%

“…However, recent studies demonstrated that the clinicopathologic and molecular features of small intestinal adenocarcinoma differed from those of colorectal cancer (1,2). The majority of small intestinal adenocarcinoma patients are diagnosed at an advanced disease stage because of a lack of early detection tools, low incidence, and nonspecific clinical symptoms (1,3). A prospective ARCAD-NADEGE cohort study found that 35.6% of patients with small intestinal adenocarcinomas were diagnosed with metastatic disease, compared to 15.6% of those with colorectal cancer (4).…”

Section: Introductionmentioning

confidence: 99%

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Loss of HES-1 Expression Predicts a Poor Prognosis for Small Intestinal Adenocarcinoma Patients

et al. 2020

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Objective: Hairy and enhancer of split-1 (HES-1), which is a downstream target of the Notch signaling pathway, has been linked to KRAS mutations. HES-1 has been proposed as harboring oncogenic activity in colorectal cancer but has not been investigated in adenocarcinoma of the small intestine, where the drivers of oncogenesis are not as well-understood. Materials and Methods: To investigate the clinicopathologic and prognostic implications of HES-1, HES-1 immunohistochemical expression was analyzed in digital images along with clinicopathological variables, including survival and KRAS genotype, in 185 small intestinal adenocarcinomas. Results: The loss of HES-1 expression (HES-1 Loss) was observed in 38.4% (71/185) of the patients, and was associated with higher pT category (P = 0.018), pancreatic invasion (P = 0.005), high grade (P = 0.043), and non-tubular histology (P = 0.004). Specifically, in tumors with mutant KRAS (KRAS MT), HES-1 Loss was related to proximal location (P = 0.024), high T and N categories (P = 0.005 and 0.047, respectively), and pancreatic invasion (P = 0.004). Patients with HES-1 Loss showed worse overall survival compared to those with intact HES-1 (HES-1 Intact) (P = 0.013). Patients with HES-1 Loss /KRAS MT (median, 17.3 months) had significantly worse outcomes than those with HES-1 Intact /KRAS WT (39.9 months), HES-1 Intact /KRAS MT (47.6 month), and HES-1 Loss /KRAS WT (36.2 months; P = 0.010). By multivariate analysis, HES-1 Loss (hazard ratio = 1.55, 95% confidence interval (CI), 1.07-2.26; P = 0.022) remained an independent prognostic factor. Conclusion: HES-1expression can be used as a potential prognostic marker and may aid in the management of patients with small intestinal adenocarcinomas.

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Section: Discussioncontrasting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Loss of HES-1 Expression Predicts a Poor Prognosis for Small Intestinal Adenocarcinoma Patients

et al. 2020

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“…The CA, when arising from the proximal loop, is long and crosses the tortuous RHA to reach the gallbladder. When the CA arises from a distal loop, it is very short, this variant being the most common [2] , [6] , [10] , [11] , [15] , [16] , [17] . In our case, the hump had a single loop with a short CA arising from its convexity.…”

Section: Discussionmentioning

confidence: 99%

Moynihan's Lump as an unusual variant of right hepatic artery during a laparoscopic cholecystectomy approach. A case report

Martín-Pérez

Rodríguez

Cruz

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance One of the most important measures during the cholecystectomy procedure is based on a “Culture for Safe Cholecystectomy (CSC)”. Vascular injury reports an open surgery conversion rate of 0 to 1.9% and a mortality of less than 0.02%. The caterpillar or Moynihan's hump configuration is characterized by a tortuous right hepatic artery (RHA) running proximal and/or parallel to the cystic duct and predisposes to a small and/or short cystic artery (CA). Case presentation A 65-year-old woman with no relevant clinical history underwent a laparoscopic cholecystectomy (LC) for cholelithiasis; during the procedure a caterpillar or Moynihan's hump was identified. Clinical discussion Anatomical variations represent 20-50% of all cases; therefore, CVS is required. The incidence of caterpillar or Moynihan's hump varies between 1% and 13% of all cases. To date, the scientific literature on this topic is limited. The most accepted etiology is related to embryological formation. Conclusion Biliary and arterial variations are more frequent than we think, so an anatomical knowledge, CSC and CVS represent a fundamental rule, increasing the safety of the surgical procedure.

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“…Currently, data regarding adjuvant chemotherapy for SBA are almost entirely limited to retrospective reports and the effect of adjuvant chemotherapy is still not conclusive. However, several retrospective studies have reported adjuvant chemotherapy to be associated with improved OS compared to no chemotherapy in both univariate and multivariate analysis (14,15).…”

Section: Discussionmentioning

confidence: 99%

Clinical features and the efficacy of adjuvant chemotherapy in resectable small bowel adenocarcinoma: a single-center, long-term analysis

Shen

Deng

et al. 2020

Ann Transl Med

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Background: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal malignancy. There is no standard regimen for adjuvant chemotherapy for treating SBA. This study aimed to assess the efficacy of adjuvant chemotherapy in patients with resectable SBA.Methods: This retrospective study collected data from 148 eligible SBA patients who received radical resection at a single institution. The patients' clinicopathological characteristics were reviewed and diseasefree survival (DFS) time and overall survival time (OS) were estimated by the Kaplan-Meier method.Results: The patients had a median age of 57 years at the time of diagnosis. In most cases, the primary tumor was located in the duodenum (75.68%). Of the 55 patients who received adjuvant chemotherapy, 43 received the combined regimen and 12 received single agent chemotherapy. During the follow-up period, 87 patients (58.87%) relapsed. The median DFS and the median OS were 19 and 32 months for all patients, respectively. Stage, N-stage, adjuvant chemotherapy, and having more than one symptom at the time of diagnosis were factors associated with DFS and OS. The 43 patients who received combined adjuvant chemotherapy generally exhibited better DFS and OS at 3 and 5 years (DFS: 75.7% and 57.3%, respectively; OS: 75.7% and 62.5%, respectively) than the patients who did not receive the same treatment. The survival time was significantly improved in patients with initial CA19-9 of less than 300 μ/mL or CEA of less than 10 ng/mL. Multivariate analysis revealed N stage and combined adjuvant chemotherapy were independent factors for DFS. However, only combined adjuvant chemotherapy could prolong OS for patients who underwent radical resection.Conclusions: In our study, both N stage and combined adjuvant chemotherapy are found to influence postoperative recurrence of SBA. Moreover, combined adjuvant chemotherapy is an independent prognostic factor of DFS and OS.

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Clinical Outcomes of Small Bowel Adenocarcinoma

Cited by 25 publications

References 27 publications

Loss of HES-1 Expression Predicts a Poor Prognosis for Small Intestinal Adenocarcinoma Patients

Loss of HES-1 Expression Predicts a Poor Prognosis for Small Intestinal Adenocarcinoma Patients

Moynihan's Lump as an unusual variant of right hepatic artery during a laparoscopic cholecystectomy approach. A case report

Clinical features and the efficacy of adjuvant chemotherapy in resectable small bowel adenocarcinoma: a single-center, long-term analysis

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