Is postoperative adjuvant chemotherapy needed for small bowel adenocarcinoma after surgical resection? - Reply

Sep 29, 2026

Letter to the editor replying to comments on a study in the Journal of the Chinese Medical Association (2024) regarding small bowel adenocarcinoma after surgical resection. The reply explains that rarity limits evidence, so postoperative adjuvant chemotherapy decisions rely on extrapolated colorectal data and multidisciplinary assessment of pathological stage and high-risk features. It outlines when observation may be suitable (stage I) and when chemotherapy is considered (stages III and high-risk stage II), noting nutrition, inflammation, and procedural factors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the editor

Reply to the question on postoperative adjuvant chemotherapy needs

Adjuvant chemotherapy indications and high-risk factors

Postoperative factors, limitations, and need for further research

Closing remarks

References

J Chin MedAssoc Letter to the editor Reply to: Is “postoperative adjuvant chemotherapy” needed for small bowel adenocarcinoma after surgical resection? Chia-Ju Lia,b,*, Pei-Chang Leea,c, Kuo-Wei Huangc,d, Kuan-Jung Huanga, Tien-En Changc,e, Ching-Chih Changb,c, Shin-E Wangc,f, Yi-Ming Shyrc,f, Chung-Pin Lic,g, Jiing-Chyuan Luoa,c, Ming-Chih Houa,c aDivision of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDivision of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cSchool of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dDivision of Gastroenterology, Department of Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan, ROC; eEndoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; fDivision of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; gDivision of Clinical Skills Training, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC DEAR EDITOR, We thank Dr. Yiu-Tai Li, Wen-Hsun Chang for the valuable comments1 and questions on our study named “Postoperative prognostic nutrition index predicts survival in patients with small bowel adenocarcinoma after surgical resection” published in Journal of the Chinese Medical Association in 2024 August.2 The authors’ comments are discussed below. Given the rarity of small bowel adenocarcinoma (SBA), the current international consensus on the need for postoperative adjuvant chemotherapy in these patients primarily depends on extrapolated data from studies on colorectal adenocarcinoma.3–6 Due to the complexity of the disease, treatment following tumor resection relies on multidisciplinary team discussions. Basically, indications for adjuvant chemotherapy are dictated by not only the pathological stage but also high-risk histological features of the tumor. Postoperatively, observation is appropriate inmost cases of stage I SBA. Patients with stage III SBA who have undergone surgical resection potentially benefit from adjuvant chemotherapy. However, the decision regarding adjuvant chemotherapy in stage II SBA depends on certain pathological characteristics. Adjuvant chemotherapy is recommended for stage II SBA patients who exhibit high-risk features. Key factors include poorly differentiated tumor, close/positive resection margins, fewer than five lymph nodes examined if the tumor is in the duodenum, fewer than eight lymph nodes examined for other small bowel primaries, lymphovascular, or perineural invasion, and perioperative bowel perforation.3 The *Address correspondence. Dr. Chia-Ju Li, Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, 201, ShiPai Road, Section 2, Taipei 112, Taiwan, ROC. E-mail address: cjlee12@vghtpe. [gov.tw](gov.tw) (C.-J. Li). Conflicts of interest: Dr. Ching-Chih Chang, Dr. Yi-Ming Shyr, Dr. Jiing-Chyuan Luo and Dr. Ming-Chih Hou, editorial board members at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2024): 1099-1100. doi: 10. 1097/JCMA.0000000000001167 Copyright © 2024, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) administration of adjuvant chemotherapy such as FOLFOX or CAPEOX may be associated with a decreased risk of recurrence and improved survival benefits. Besides traditional tumor factors such as pathological stage and

FAQs

Why is evidence on postoperative adjuvant chemotherapy for small bowel adenocarcinoma limited?

The letter attributes it to the rarity of small bowel adenocarcinoma, so international consensus largely depends on extrapolated colorectal adenocarcinoma data.

When is observation considered appropriate after surgery?

Observation is described as appropriate in most cases of stage I small bowel adenocarcinoma.

Which stage II features support recommending adjuvant chemotherapy?

Stage II patients with high-risk features may be recommended for adjuvant chemotherapy, including poorly differentiated tumor, close/positive resection margins, limited lymph node examination thresholds, lymphovascular or perineural invasion, and perioperative bowel perforation.

Sep 29, 2026

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