PAEA Surgery End Of Rotation (EOR) Practice Exam

What is the recommended surgical management for adenocarcinomas of the small intestine?

1. Endoscopic resection

2. Wide resection of the involved bowel with wide margins

3. Chemotherapy alone

4. Radiation therapy

The correct answer is: Wide resection of the involved bowel with wide margins

The recommended surgical management for adenocarcinomas of the small intestine is to perform a wide resection of the involved bowel with wide margins. This approach is critical because small intestine adenocarcinomas tend to be aggressive and often have a higher risk of local recurrence and metastasis. Achieving clear margins during resection minimizes the likelihood of residual cancer cells being left behind, which could lead to a recurrence. In addition to providing the best chance for long-term survival, wide resection ensures that any affected lymphatic tissue is also removed, as regional lymph node involvement can be a concern with these tumors. The goal of this surgical strategy is to reduce the risk of both local and distant spread of the cancer. Other management options, such as endoscopic resection, chemotherapy alone, or radiation therapy, are not typically sufficient for adenocarcinomas of the small intestine, given the nature of the disease and its tendency to require comprehensive surgical intervention to address both the tumor and potential metastasis effectively. While endoscopic resection might be applicable in very select cases or early lesions, it is not the standard approach for most adenocarcinomas in this location due to the generally more invasive nature of these tumors.