Clinicopathological Profiles and Outcomes of Small Bowel Tumors: A 15-Year Experience at a Tertiary Care Center in South India

Introduction Small bowel tumors (SBTs) are uncommon and often present with nonspecific clinical features, leading to delayed diagnosis and poor outcomes. This study aimed to evaluate the clinicopathological profile, management, and outcomes of SBTs over a 15-year period at a tertiary care center in South India. Methods We conducted a retrospective observational study at Government Medical College, Thrissur, including all histopathologically confirmed SBTs between January 2011 and December 2025. Demographic, clinical, pathological, and treatment data were analyzed. Survival outcomes were assessed based on available follow-up data. Results A total of 542 patients were included (median age 61 years; range 22-85), with a male predominance (356/542, 65.7%). The most common presenting symptom was abdominal pain (302/542, 55.7%), followed by vomiting (168/542, 31.0%), intestinal obstruction (142/542, 26.2%), gastrointestinal bleeding or anemia (98/542, 18.1%), and weight loss or jaundice (47/542, 8.7%). Males were more likely to present with abdominal pain or obstruction than females (χ²(1) = 4.13, p = 0.042, Cramer’s V = 0.09). Tumor location was duodenum in 246/542 (45.4%), jejunum in 163/542 (30.1%), ileum in 108/542 (19.9%), and multifocal in 25/542 (4.6%), with proximal tumors being significantly more frequent than distal tumors (χ²(1) = 16.82, p < 0.001, Cramer’s V = 0.18). Histopathology revealed 388/542 (71.6%) malignant tumors, including adenocarcinoma 214/542 (39.5%), lymphoma 58/542 (10.7%), neuroendocrine tumors 41/542 (7.6%), gastrointestinal stromal tumors (GISTs) 37/542 (6.8%), and metastatic tumors 38/542 (7.0%). Benign tumors (154/542, 28.4%) included adenomas or hyperplastic polyps 65/542 (12.0%), low-risk GISTs 52/542 (9.6%), lipomas 22/542 (4.1%), and hamartomas 15/542 (2.8%), with malignant tumors being significantly more common in the duodenum than in the jejunum or ileum (χ²(2) = 8.69, p = 0.013, Cramer’s V = 0.13). Curative surgical resection was performed in 328/542 (60.5%), palliative procedures in 74/542 (13.6%), and endoscopic removal in 42/542 (7.7%). Among malignant tumors (n = 388), 202/388 (52.1%) were stage III or IV at presentation, which was strongly associated with reduced three-year overall survival (OS) (χ²(1) = 28.91, p < 0.001, Cramer’s V = 0.27). Extrapolated survival analysis showed a three-year OS of 130/186 (69.9%) for early-stage disease versus 31/98 (31.6%) for stage IV disease (p < 0.001), and jejunal tumors demonstrated superior survival compared to duodenal tumors (χ²(1) = 5.34, p = 0.021, Cramer’s V = 0.10). Conclusion SBTs are rare and frequently present at advanced stages. Duodenal adenocarcinoma is the predominant malignancy in this cohort. Early diagnosis and timely surgical intervention are essential to improve outcomes.