Though small intestine accounts for 75% in the length and 90% in the mucosal surface of the gastrointestinal tract, primary small bowel cancer is relatively rare. So characteristics of smal1 bowel cancer are not known precisely. We analyzed 63 cases of the primary small bowel cancer(except ampulla of Vater cancer) that were operated at the department of surgery, Seoul National University Hospital from 1980 to 1994. The clinical features, diagnostic method, tumor location, histologic findings, preoperative diagnotic accuracy and type of operation were analyzed. The results were as follows; 1) There were 37 men and 26 women, ranging from 24 years to 95 years of age. The most prevalent age group was 6th decade(25 cases, 40%). 2) There were 28 adenocarcinomas, 18 lymphomas, 13 leiomyosarcomas, 3 carcinoid tumors and I liposarcoma, 3) The primary sites were the duodenum in 26, jeiunum in 13, ileum in 25 patients. The adenocarcinoma ocurred most frequently in duodenum(24/28,86%), lymphoma in ileum(17/18, 94%) and leiomyosarcoma in the jejunum(13/19,77%) 4) The most frequent chief complaint was abdominal pain(53%) followed by hemorrhage (21%), abdominal mass, obstructive symptom, jaundice and so on. 5) The average duration of symptoms of adenocarcinoma was 6 months, lymphoma 4 months, leiomyosarcoma 9 months and carcinoid 3 months 6) The correct diagnosis was made preoperatively in 59% of cases. Preoperative diagnosis of duodenal cancer was made by UGI series and/or endoscopy(79%). Jejunal and ileal cancers were diagnosed preoperatively by small bowel series and/or abdominal CT(44%). 7) Curative resection was possible in 54%. Palliative resection, bypass surgery, open biopsy were performed in 46% cases because of the distant metastasis or irresectability. 8) The median duration of recurrence,among the recurrent cases was 15 months. Adenocarcinoma had the poorer prognosis. Median disease free survivals in adenocarcinoma were 12.6 months, lymphoma 16 months and leiomyosarcoma 27 months. Median disease free survivals in curative resection group was 26 manths compared to 10 months in palliation group. We concluded that the most important factor determining the prognosis of small bowel cancer patient may be initial stage of cancer at the time of the first diagnosis.
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