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Adenokarzinome des Dünndarms

Eine Krankheit, an die selten gedacht wird

Adenocarcinoma of small bowel

An underdiagnosed disease

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Zusammenfassung

Hintergrund

Dünndarmkarzinome sind insgesamt sehr selten. Die Diagnose ist häufig erschwert durch unspezifische und wechselnde Symptome. Adenokarzinome des Dünndarms werden häufig erst im fortgeschrittenen Stadium nachgewiesen, dann zumeist mit einer schlechten Prognose.

Methodik

Beschrieben werden Diagnostik, Therapie und Verlauf bei einer konsekutiven Serie von 42 Patienten mit Adenokarzinomen des Dünndarms, die zwischen 1995 und 2009 in zwei chirurgische Kliniken vorstellig wurden.

Ergebnisse

Die Tumoren waren bei 21 Patienten (50%) im Duodenum bei 16 (38%) im Jejunum und bei 5 (12%) im Ileum. Die 5-Jahres-Überlebensrate aller Patienten betrug 20% bei einer medianen Überlebenszeit von 19 Monaten. Statistisch signifikanten Einfluss auf die Überlebensraten bei den resezierten Patienten hatten univariat der präoperative Allgemeinzustand, die R-Klassifikation und das Tumorstadium. In der multivariaten Analyse erwiesen sich Residualtumor und pT-Kategorie als unabhängige Prognosefaktoren.

Schlussfolgerung

Die vollständige (R0) Tumorresektion stellt die einzige Chance auf Langzeitüberleben dar. Zukünftige Untersuchungen sollten sich daher auf die Früherkennung, aber auch auf adjuvante Therapieverfahren zielen. Gründe für die späte Diagnose sind wohl die geringe Spezifität der Symptome und die Seltenheit der Erkrankung.

Abstract

Background

Small bowel adenocarcinoma is a rare disease. The diagnosis is often disguised by nonspecific and varied presenting symptoms. Adenocarcinoma of the small bowel is typically detected at a late stage and with a poor prognosis.

Patients and methods

The records of 42 patients with small bowel adenocarcinomas diagnosed in 2 surgical clinics between 1995 and 2009 were reviewed for patient and tumor characteristics, treatment effects and survival.

Results

The tumor locations were the duodenum (50%), jejunum (38%) and ileum (12%). In comparison to patients seen before 2004 the observed frequency of emergency operations or palliative procedures as well as stage distribution did not change. The median overall survival was 19 months with a 5-year overall survival of 20%. For patients with resections, reduced performance status, higher stage and residual disease after resection predicted decreased overall survival in univariate analysis. Residual disease and pT category were predictive of survival in multivariate analysis.

Conclusion

Complete resection provides the only means of a cure. In cases where curative resection cannot be performed the prognosis remains poor. Further study on the methods for early detection and effective adjuvant chemotherapy should be investigated, however, the available data are limited.

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Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus St. Joseph-Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland

    W. Sendt

  2. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universität Jena, Jena, Deutschland

    C. Wurst, U. Settmacher & A. Altendorf-Hofmann

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  1. W. Sendt
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  2. C. Wurst
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Correspondence to W. Sendt.

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Sendt, W., Wurst, C., Settmacher, U. et al. Adenokarzinome des Dünndarms. Chirurg 83, 374–380 (2012). https://doi.org/10.1007/s00104-011-2159-8

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