Small intestine resection

Small intestine resection, also called small bowel resection, removes a section of the small intestine. For a tumour in this part of the bowel, this can mean removing the section containing the tumour. A laparoscopic approach, using small incisions, was described in a 2021 report of a woman whose tumour was identified as a neuroendocrine tumour. Her surgeon used several small access points to remove the affected bowel and minimise the size of the wound.

For small bowel neuroendocrine tumours that have already spread elsewhere at diagnosis, one treatment choice is whether to remove the original bowel tumour early or manage the disease without an initial bowel operation. A 2022 study compared these approaches in adults in Ontario, defining early surgery as resection within six months of diagnosis. This comparison concerns metastatic neuroendocrine tumours specifically, rather than every type of small bowel cancer.

In the 2022 Ontario study, researchers compared matched groups of 348 adults who had early surgery and 174 who initially had nonoperative management for metastatic small bowel neuroendocrine tumours. The estimated risk of a later unplanned acute-care admission over three years was 72.6% after early surgery, compared with 86.4% with initial nonoperative management. Because this was a comparison of past medical records rather than a randomised trial, the association does not establish that surgery alone caused the difference.

Further bowel treatment can still be needed after an initial resection. The metastatic neuroendocrine tumour study found a lower risk of later small bowel-related surgery in the early-surgery group than in the group initially managed without an operation. Problems at the abdominal incision are another consideration: in the 2021 report of a woman with a small bowel neuroendocrine tumour and obesity, the surgical team used a small extraction incision and careful wound closure to try to prevent an incisional hernia, a bulge through the operation scar.

A new finding on a follow-up scan may need further investigation to establish what it is. In a 2019 report, a man had part of his small bowel removed for a gastrointestinal stromal tumour, or GIST, and then received imatinib because of a high risk of the tumour returning. After 2.5 years of treatment, a CT scan showed a new nodule. It was removed and examined, and proved to be a different tumour, called a desmoid tumour, rather than a return of the GIST.