Surgery for Small Intestine Adenocarcinoma
Surgery is the main treatment for small intestine cancer and it’s often the only treatment. At this time, surgery is the only treatment that can cure a cancer of the small intestine. The type of operation will depend on a number of factors, including the size and location of the tumor, and whether the patient has any serious diseases of other organs.
Usually this surgery is done through a cut made in the abdomen. This operation removes the piece of intestine that has the tumor and some of the normal tissue on either side of the tumor. The 2 cut ends of intestine are then sewn back together. Some nearby tissue containing lymph nodes will also be removed. After surgery, it can take a few days before the patient can eat and drink normally. Removing a small piece of intestine usually doesn’t cause long-term problems with eating or bowel movements.
Pancreaticoduodenectomy (Whipple procedure)
This operation is used to treat cancers of the duodenum, although it is more often used to treat pancreatic cancer. It removes the duodenum, part of the pancreas, nearby lymph nodes and part of the stomach. The gallbladder and part of the common bile duct are removed and the remaining bile duct is attached to the small intestine so that bile from the liver can continue to enter the small intestine.
This is a complex operation that requires a lot of skill and experience. It carries a relatively high risk of complications that could even be fatal. When the operation is done in small hospitals or by doctors with less experience, more than 15% of patients may die as a result of surgical complications. In contrast, when this operation is done in cancer centers by surgeons experienced in the procedure, less than 5% of patients die as a direct result of complications from surgery. In general, people having this type of surgery do better when it is done at a hospital that does at least 20 of these procedures a year. Still, even in the best hands, many patients suffer complications from the surgery. These can include:
- Leaking from the various connections that the surgeon has to make
- Trouble with the stomach emptying itself after eating
Most, if not all, patients who have this surgery lose a lot of weight.
If the cancer cannot be completely removed because it has spread too far in the abdomen, the surgeon may do an operation to help improve some of the symptoms that the cancer is causing. This is known as palliative surgery. Often, these operations are done to relieve a blocked intestine, to decrease pain, nausea, and vomiting, and allow the patient to eat normally for some time. If possible, the surgeon will remove enough of the tumor and nearby intestine to allow digested food to pass through.
Sometimes, the surgeon will leave the tumor in place and route the normal small intestine around the tumor so that any blockage is relieved or prevented.
In very advanced situations, a fairly rigid tube (called a stent) is passed through the blocked area and left in place so digested food can pass. If this can’t be done, a tube may be placed in the stomach to drain it and decrease problems with nausea and vomiting.
For more general information about surgery, please see A Guide to Cancer Surgery.
Last Medical Review: April 30, 2014 Last Revised: February 9, 2016