Primary tumors of the small intestine

In our department of surgery 28 patients with malignant and 10 with benign tumors of the small intestine were treated from 1940 to 1974. Fifteen patients with malignant and 7 with benign tumors underwent surgery with the intention to cure. Palliative operations or explorations were carried out on 13 patients with malignant tumors. Three patients with benign tumors were not operated on. The initial symptoms were vague: abdominal pain, nausea, anemia or bleeding in 75 and 80 percent of patients with malignant and benign tumors, respectively. The indication for operation in the malignant cases was, however, stenosis of the intestine or biliary tract or a palpable mass in 60 percent of the cases. At operation the tumors were thus in an advanced stage. Because the initial symptoms are vague, early diagnosis is difficult.The overall 5 year survival rate was 21 percent after surgery for malignant tumors. Among the patients considered by the surgeons to have had radical operations excluding cancer patients, 40 percent survived 5 years. The surgeon's opinion regarding “radical” operation as well as the presence or absence of metastases at microscopy were of limited prognostic value.     

Primary tumors of the small intestine

Seventy-two malignant and 19 benign tumors were seen at the Veterans Administration Hospital, Hines, Illinois, from 1950 to 1976. Of these, 44 malignant and 14 benign tumors were seen in the clinical setting--the remainder were found at autopsy. Carcinoid tumors were the most common malignant tumors, followed by adenocarcinoma, lymphoma and leiomyosarcoma. Patients with malignant tumors usually presented with abdominal pain, vomiting and weight loss. The most common clinical signs were anemia, abdominal tenderness and abdominal distention. The most useful diagnostic tests were upper GI series and plain x-ray of the abdomen. Twenty-one (50%) five year survivals and 14 (33%) ten year survivals were obtained with small bowel malignancies. The majority of the five and ten year survivals were patients who had carcinoid tumors and lymphoma. Various theories on the causation of small bowel malignancies are discussed.     

Primary tumors of the small intestine

From 1950 through 1984, 48 cases of primary tumors of the small bowel were treated at the First Surgical Clinic of the University, La Sapienza, of Rome. Forty-three were malignant and five were benign tumors: 13 in the duodenum, 16 in the jejunum and 19 in the ileum. Abdominal pain, weight loss and obstruction were the most common complaints at admission. Radiographic studies of the gastrointestinal tract were diagnostic in 48% of patients. Four benign tumors were leiomyoma of the jejunum or ileum, the other benign tumor was a Brunner's adenomatosis of the duodenal bulb. The tumors were adenocarcinomatous in 29% of the cases and 50% of them were located in the duodenum. The five-year survival of patients with adenocarcinoma was 11%. The fourteen lymphomas were distributed evenly throughout the small bowel: 40% of the patients with lymphoma were alive after five years. Malignant smooth muscle tumors were found in the jejunum and ileum, in these cases the five-year survival rate was 50%. All the carcinoid tumors were in the ileum. The best five-year survival rate, 66%, was seen in patients with this type of tumor. In the malignant group, the five-year survival rate after curative resections was 25% in patients with positive nodes and 75% in those without nodal involvement.     

Primary tumors of the small intestine

The authors had 27 patients with tumors of the small intestine. In 23 the tumors were malignant and in 4 patients--benign. Adenocarcinoma and sarcoma were encountered in 85.5% of cases. In 22 of the 27 patients the diagnosis was established only after complications (obstructive ileus, perforation, hemorrhage) developed. The difficult diagnosis of tumors of the small intestine has a negative effect on the results of surgical treatment. In the group of 23 patients with malignant tumors 15 were treated by a radical operation. All were discharged from the clinic; 8 have a survival period of less than 5 years, 7 have a survival period of over 5 years. It is concluded that only early diagnosis can improve the results of the operation.     

Primary malignant tumors of the small intestine: A twenty-two year experience with thirty patients

A review of thirty cases of primary malignant small bowel tumors is presented. Chronic obstruction was the presenting symptom most frequently encountered, with an acute abdomen from perforation of the tumor next in frequency. Adenocarcinoma and carcinoid were about equally encountered, and more than half of all tumors were found in the ileum. Three patients are alive and well, two are alive on chemotherapy, and all others are dead. Five of these died of other causes. Of twenty-seven patients explored for symptomatic small bowel cancers, only one is alive free of tumor. Malignant small bowel tumors are difficult to diagnose early and have a poor prognosis.