Abstract
We reviewed 45 patients who underwent surgery for primary jejunoileal tumors over a 15-year period. There were 16 benign and 29 malignant tumors, which included 13 lymphomas, 7 adenocarcinomas, 7 carcinoid tumors, and 2 leiomyosarcomas. Eighteen patients, 13 of whom had benign tumors, presented with intestinal bleeding and 5 tumors were found incidentally at laparotomy. Benign lesions were more frequently sited in the jejunum while malignant lesions were more common in the ileum (p<0.001). Lesions presenting with hemorrhage were more likely to be benign than malignant (p<0.001) and were more commonly sited in the jejunum than in the ileum (p<0.05). Visceral perforation (31%), intestinal obstruction (21%), and an abdominal mass (17%) were other presenting features in patients with malignant tumors. In spite of a wide variety of investigations, the correct diagnosis was reached preoperatively in only 31% of patients. Surgical management included either limited bowel resection or segmental resection with regional lymphadenectomy. Operative mortality was 13% and morbidity was 36%. Actuarial 5-year survival for all malignant tumors was 24%, being 64% at 5 years for carcinoid tumors, 20% at 30 months for adenocarcinomas, and 10% at 42 months for lymphomas. These results reemphasize the need for a high index of suspicion and early laparotomy in patients with obscure intestinal symptoms if the prognosis of small bowel tumors is to improve.
Résumé
Nous avons revu les dossiers de 45 patients opérés pour des tumeurs primitives jéjuno-iléaies sur une période de 15 ans. Il y avait 16 tumeurs bénignes et 29 malignes dont 13 lymphomes, 7 adénocarcinomes, 7 tumeurs carcinoÏdes, et 2 léiomyosarcomes. Dix-huit patients, dont 13 avaient des tumeurs bénignes, avaient comme signe principal une hémorragie intestinale et 5 tumeurs ont été découvertes fortuitement lors d'une laparotomie. Les lésions bénignes étaient plus souvent localisées au jéjunum tandis que les lésions malignes étaient situées plus fréquemment à l'iléon (p<0.001). Les lésions hémorragiques s'averaient bénignes plus souvent que malignes (p<0.001) et elles étaient situées plutôt au jéjunum qu'à l'iléon (p<0.05). Perforation intestinale (31%), occlusion intestinale (21%), et masse abdominale (17%) étaient les autres signes et symptômes retrouvés chez les patients ayant des tumeurs malignes. Malgré une grande variété d'investigations, on était arrivé au bon diagnostic préopératoire chez 31% des patients seulement. Le traitement chirurgical comprenait soit une résection partielle de l'intestin, soit une résection segmentaire avec lymphadénectomie locorégionale. Le taux de mortalité opératoire était de 13% et celui de morbidité de 36%. La survie actuarielle à 5 ans était de 24% pour l'ensemble des tumeurs malignes, de 64% à 5 ans pour les tumeurs carcinoÏdes, de 20% à 30 mois pour les adénocarcinomes, et de 10% à 42 mois pour les lymphomes. Ces résultats prouvent une fois de plus la nécessité de penser systématiquement au diagnostic et de pratiquer tôt la laparotomie chez les patients à Symptomatologie intestinale peu évidente, seule faÇon à améliorer le pronostic des tumeurs de l'intestin grÊle.
Resumen
Hemos revisado 45 pacientes sometidos a cirugía por tumores yeyunoileales primario en un período de 15 años. Hubo 16 tumores benignos y 29 malignos, que incluyeron 13 línfomas, 7 adenocarcinomas, 7 carcinoides, y 2 leiomiosarcomas. Dieciocho pacientes, 13 de los cuales tenían tumores benignos, se presentaron con sangrado intestinal y 5 tumores fueron hallados en forma incidental en el curso de laparotomía. Las lesiones benignas se ubicaron con mayor frecuencia en el yeyuno, en tanto que las lesiones malignas fueron más frecuentes en el ileon (p<0.001). Las lesions que se presentaron con hemorragia con mayor frecuencia resultaron benignas (p<0.001) y tuvieron ubicación más frecuente en el yeyuno que en el ileon (p <0.05). La perforación visceral (31%), la obstrucción intestinal (21%), y una masa abdominal (17%) constituyeron otras características de los pacientes con tumores malignos. A pesar de la realización de una amplia variedad de procedimientos, sólo se logró un diagnóstico preoperatorio correcto en 31% de los pacientes. El tratamiento quirÚrgico incluyó la resección segmentaria con linfadenectomía regional. La mortalidad operatoria fue 13% y la morbilidad 36%. La sobrevida actuarial a 5 años para la totalidad de los tumores malignos fue 24%, siendo 64% a los 5 años para los tumores carcinoides, 20% a los 30 meses para los adenocarcinomas, y 10% a los 42 meses para los línfomas. Estos resultados refuerzan la necesidad de mantener un alto índice de sospecha y de realizar laparatomía precoz en pacientes con síntomas intestinales oscuros si es que pretendemos mejorar el pronóstico de los tumores del intestino delgado.
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Desa, L.A.J., Bridger, J., Grace, P.A. et al. Primary jejunoileal tumors: A review of 45 cases. World J. Surg. 15, 81–86 (1991). https://doi.org/10.1007/BF01658970
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DOI: https://doi.org/10.1007/BF01658970