Skip to main content

Open Technique for Resection of Cancers of the Jejunum and Ileum

  • 1948 Accesses

Abstract

Although relatively rare, the incidence of small bowel cancer has steadily increased over the past two decades. The most common tumors of the small intestine include: adenocarcinoma, gastrointestinal stromal tumors, lymphomas, and gastrointestinal neuroendocrine tumors. These tumors often remain asymptomatic until late in their course, which makes timely diagnosis difficult. For most small bowel tumors, surgical resection in a timely manner remains the only potentially curative treatment option. The principles of surgical treatment include thorough exploration of the abdomen to identify the primary tumor and any metastatic disease followed by wide en bloc resection of the primary tumor. Bowel continuity is then achieved through an isoperistaltic anastomosis.

Keywords

  • Small bowel cancer
  • Open resection
  • Jejunum
  • Ileum
  • Technique

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4939-1893-5_13
  • Chapter length: 7 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   99.00
Price excludes VAT (USA)
  • ISBN: 978-1-4939-1893-5
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   129.00
Price excludes VAT (USA)
Fig. 13.1
Fig. 13.2
Fig. 13.3

References

  1. Bilimoria KY, et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249(1):63–71.

    PubMed  CrossRef  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2013;63(1):11–30.

    PubMed  CrossRef  Google Scholar 

  3. Lowenfels AB. Why are small-bowel tumours so rare? Lancet. 1973;1(7793):24–6.

    CAS  PubMed  CrossRef  Google Scholar 

  4. Wattenberg LW. Studies of polycyclic hydrocarbon hydroxylases of the intestine possibly related to cancer. Effect of diet on benzpyrene hydroxylase activity. Cancer. 1971;28(1):99–102.

    CAS  PubMed  CrossRef  Google Scholar 

  5. Calman KC. Why are small bowel tumours rare? An experimental model. Gut. 1974;15(7):552–4.

    CAS  PubMed Central  PubMed  CrossRef  Google Scholar 

  6. Moore KL. Clinically oriented anatomy. 5th ed. Baltimore: Lippincott Williams and Wilkins; 2006.

    Google Scholar 

  7. Dabaja BS, et al. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer. 2004;101(3):518–26.

    PubMed  CrossRef  Google Scholar 

  8. Cobrin GM, Pittman RH, Lewis BS. Increased diagnostic yield of small bowel tumors with capsule endoscopy. Cancer. 2006;107(1):22–7.

    PubMed  CrossRef  Google Scholar 

  9. Yamamoto H, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53(2):216–20.

    CAS  PubMed  CrossRef  Google Scholar 

  10. Yamamoto H, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004;2(11):1010–6.

    PubMed  CrossRef  Google Scholar 

  11. Lo SK, Mehdizadeh S. Therapeutic uses of double-balloon enteroscopy. Gastrointest Endosc Clin N Am. 2006;16(2):363–76.

    PubMed  CrossRef  Google Scholar 

  12. Boudreaux JP, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the jejunum, ileum, appendix, and cecum. Pancreas. 2010;39(6):753–66.

    PubMed  CrossRef  Google Scholar 

  13. Feig BW, Ching CD. The MD Anderson surgical oncology handbook. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2012.

    Google Scholar 

  14. Howe JR, et al. The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995. Cancer. 1999;86(12):2693–706.

    CAS  PubMed  CrossRef  Google Scholar 

  15. Overman MJ, et al. Is there a role for adjuvant therapy in resected adenocarcinoma of the small intestine. Acta Oncol. 2010;49(4):474–9.

    PubMed  CrossRef  Google Scholar 

  16. Hellman P, et al. Effect of surgery on the outcome of midgut carcinoid disease with lymph node and liver metastases. World J Surg. 2002;26(8):991–7.

    PubMed  CrossRef  Google Scholar 

  17. Dematteo RP, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373(9669): 1097–104.

    CAS  PubMed Central  PubMed  CrossRef  Google Scholar 

  18. Joensuu H, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA. 2012;307(12): 1265–72.

    CAS  PubMed  CrossRef  Google Scholar 

  19. Koniaris LG, et al. Management of gastrointestinal lymphoma. J Am Coll Surg. 2003;197(1):127–41.

    PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Syed A. Ahmad M.D. .

Editor information

Editors and Affiliations

Key Operative Steps

Key Operative Steps

  1. 1.

    Exploratory laparotomy to identify primary tumor and assess for multicentric and metastatic disease.

  2. 2.

    Perform wide en bloc resection of primary tumor with 6 cm margins.

  3. 3.

    Resect adjacent mesentery and adherent structures.

  4. 4.

    Reestablish bowel continuity with hand-sewn two-layer anastomosis: outer interrupted layer with 3–0 silk suture and inner running layer with 3–0 absorbable suture.

  5. 5.

    Alternatively, reestablish bowel continuity with stapled side-to-side enteroenterostomy using GIA linear stapler (1.5 mm closed staple height). Close enterotomy with 3–0 silk sutures.

  6. 6.

    Close mesenteric defect with simple interrupted sutures to prevent herniation.

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Wilson, G.C., Ahmad, S.A. (2015). Open Technique for Resection of Cancers of the Jejunum and Ileum. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)