The management of adenocarcinoma of the small intestine depends primarily on tumor location. Which of the following statements concerning surgical management are true?
- Radical pancreaticoduodenectomy (Whipple resection) is necessary for resection of most duodenal adenocarcinomas
- Adenocarcinomas of the jejunum or ileum are managed by limited segmental resection including resection of the mesentery down to the first vascular arcade
- Distal ileal carcinomas are best managed by right hemi-colectomy to include lymph node chains along the ileocecal blood supply
- Small invasive adenocarcinomas of the ampulla and peri-ampullary duodenum can frequently be managed by local excision
Medicine
a. Radical pancreaticoduodenectomy (Whipple resection) is necessary for resection of most duodenal adenocarcinomas
c. Distal ileal carcinomas are best managed by right hemi-colectomy to include lymph node chains along the ileocecal blood supply
Optimal surgical treatment of adenocarcinoma of the small intestine requires wide, segmental resection, including the draining nodal system. For most duodenal adenocarcinomas, a radical pancreaticoduodenectomy (Whipple procedure) is necessary to incorporate pertinent training lymph nodes. Although local excision of villous adenomas of the periampullary area has been reported, the presence of invasive carcinoma warrants wider resection as a pancreaticoduodenectomy. Jejunal and ileal carcinomas are removed with segmental resections with adequate margins on the bowel and wide resection of the mesentery with associated lymph nodes down to the superior mesenteric artery. Distal ileal carcinomas are drained by lymph nodes along the ileocolic artery and are best managed by right hemicolectomy.
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