Inoue Yoshihiro, Hayashi Michihiro, Satou Nayuko, Miyamoto Yoshiharu, Hirokawa Fumitoshi, Asakuma Mitsuhiro, Shimizu Tetsunosuke, Kayano Hajime, Yamamoto Masashi, Yamana Hidenori, Okuda Junji, Egashira Yutaro, Tanigawa Nobuhiko
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
J Gastrointest Cancer. 2012 Jun;43(2):272-8. doi: 10.1007/s12029-011-9290-0.
Small bowel adenocarcinoma is a relatively uncommon neoplasm that accounts for approximately 0.3% to 2.4% of digestive cancers. In comparison with carcinomas of the other areas of the gastrointestinal tract, the prognosis for small bowel adenocarcinoma is generally worse. The prognostic factors of small bowel adenocarcinoma were analyzed retrospectively, and the significance of operative procedure, lymphadenectomy, and adjuvant chemotherapy was evaluated.
From 1990 to 2009, 30 patients with small bowel adenocarcinoma who underwent surgery at Osaka Medical College Hospital were analyzed with respect to tumor extent, operation method, and prognosis.
Overall 5-year survival was 52.5%, and the median survival time was 27.0 months. On univariate and multivariate analyses, the location (duodenum vs. jejunum and ileum), size (greater or less than 70 mm), and tumor, nodes, and metastasis (TNM) stage (stage 0 + I + II vs. III + IV) of the tumor were the significant prognostic factors. No differences in survival and recurrence rates were observed between patients undergoing pancreaticoduodenectomy and those undergoing partial resection, between those undergoing mural lymphadenectomy and those undergoing extended lymphadenectomy, or between those with and without adjuvant chemotherapy. The combination of surgery and adjuvant chemotherapy did not control recurrence or improve the prognosis.
In small bowel adenocarcinoma, location, size, and TNM stage of the tumors were the independent prognostic factors after curative resections. Partial resection with mural lymphadenectomy may be recommended as optimal surgery for small bowel adenocarcinoma.
小肠腺癌是一种相对罕见的肿瘤，约占消化道癌症的0.3%至2.4%。与胃肠道其他部位的癌症相比，小肠腺癌的预后通常更差。回顾性分析小肠腺癌的预后因素，并评估手术方式、淋巴结清扫术和辅助化疗的意义。
对1990年至2009年在大阪医科大学医院接受手术的30例小肠腺癌患者的肿瘤范围、手术方法和预后进行分析。
总体5年生存率为52.5%，中位生存时间为27.0个月。单因素和多因素分析显示，肿瘤的位置（十二指肠与空肠和回肠）、大小（大于或小于70mm）以及肿瘤、淋巴结和转移（TNM）分期（0+I+II期与III+IV期）是重要的预后因素。接受胰十二指肠切除术的患者与接受部分切除术的患者、接受壁层淋巴结清扫术的患者与接受扩大淋巴结清扫术的患者、接受辅助化疗与未接受辅助化疗的患者之间，生存率和复发率均无差异。手术与辅助化疗联合应用并不能控制复发或改善预后。
在小肠腺癌中，肿瘤的位置、大小和TNM分期是根治性切除术后的独立预后因素。对于小肠腺癌，推荐行部分切除并加壁层淋巴结清扫术作为最佳手术方式。
