Mehmet Fatih DAŞIRAN, Ahmet AKBAŞ, Hasan DAGMURA, Emin DALDAL, Faik Alev DERESOY, İsmail OKAN

Malignitede İnce Bağırsak Rezeksiyonu

Amaç: İnce bağırsak tümörlerinin teşhisi, spesifik semptom eksikliği ve de konvansiyonel endoskopi ve görüntüleme yöntemlerinin yetersizliği nedeniyle genellikle gecikir. Bu çalışmada malign vakalarda ince bağırsak rezeksiyonlarının klinik ve patolojik özelliklerini değerlendirmek ve erken tanı için gerekli yaklaşımları belirlemek amaçlanmıştır. Yöntem: 2012–2019 yıllarında primer veya metastatik tümörler için ince bağırsak rezeksiyonu uygulanan hastalar retrospektif olarak değerlendirildi. Demografik veriler, tanı çalışmaları, cerrahi tedavi yöntemleri, histopatolojik özellikler ve takip parametreleri incelendi. Bulgular: Çalışmaya yaş ortalaması 59 yıl olan 61 hasta (38 erkek, 23 kadın) dahil edildi. Yirmi dört hastada primer ince bağırsak tümörü, 37 hastada metastatik tümör vardı. Adenokarsinom en yaygın primer tümör tipi iken metastatik tutulum için en yaygın köken kolon idi. Yirmi (%32) hastada acil operasyon uygulandı. Akut mekanik bağırsak tıkanıklığı acil cerrahi için en yaygın endikasyondu. Kırk bir (%68) hastada elektif operasyon uygulandı. En sık görülen semptom karın ağrısı olup bunu kilo kaybı, iştahsızlık, bulantı ve kusma, kabızlık ve ishal izlemekteydi. Sonuç: Prognozu belirleyen en önemli parametreler histolojik tip ve tümör evresidir. Spesifik olmayan karın şikayetlerinin ayırıcı tanısında ince bağırsak tümörlerinin göz önünde bulundurulması hastalığın erken teşhisi için kritik önemdedir.

Anahtar Kelimeler:

adenokarsinom, ince barsak, malignite, metastaz

Small Bowel Resection in Malignancy

Aim: The diagnosis of small bowel (SB) tumors is often delayed due to the lack of specific symptoms and inadequacy of conventional endoscopic and imaging methods. In this study, we aimed to evaluate the clinical and pathological features of SB resections in patients with malignancy and determine the necessary approaches for early diagnosis. Methods: Patients who underwent SB resections for primary or metastatic tumors between 2012 and 2019 were evaluated retrospectively. Demographic data, diagnostic workup, surgical treatment patterns, histopathological features, and outcome parameters were documented. Results: The study included 61 patients (38 males, 23 females), with a mean age of 59 years. Twenty-four patients had primary SB tumors and 37 had metastatic tumors. Adenocarcinoma was the most common type of primary tumor while the colon was the most common origin for metastatic involvement. Twenty (32%) patients underwent emergency operations. Acute mechanical intestinal obstruction was the most common indication for emergency surgery. Forty-one (68%) patients underwent elective operations. The most common symptom was abdominal pain, followed by weight loss, loss of appetite, nausea and vomiting, and constipation and diarrhea. Conclusion: The most important parameters that determine the prognosis are histological type and tumor stage. Considering SB tumors during the differential diagnosis of non-specific abdominal complaints is critically important for the early diagnosis of the disease

Keywords:

adenocarcinoma, malignancy, metastasis, small bowel,

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Bosman FT, Hamilton SR, Lambert R. Colorectal can¬cer. In: Stewart BW, Wild CP (ed.), World Cancer Report 2014. Lyon: XXX; 2014:392–402.
The American Cancer Society. Cancer Facts & Figures 2018. Atlanta, GA: The American Cancer Society; 2018.
Oh SJ, Park SY, Kim JY, Yim H, Jung Y, Han SH. Small bowel obstruction from distant metastasis of prima¬ry breast cancer: a case report. Ann Surg Treat Res. 2018;94(2):102–5.
Memon Z, Ferm S, Fisher C, Hassam A, Luo J, Kim SH. Rare case of duodenal metastasis from pulmonary squa¬mous cell carcinoma. J Investig Med High Impact Case Rep. 2017;5(4):23–4.
Mueller JL, Guyer RA, Adler JT, Mullen JT. Metastatic renal cell carcinoma to the small bowel: three cases of GI bleeding and a literature review. CEN Case Rep. 2018;7(1):39–43.
Williamson JM, Williamson RC. Small bowel tu¬mors: pathology and management. J Med Assoc Thai. 2014;97(1):126–37.
Idelevich E, Kashtan H, Mavor E, Brenner B. Small bow¬el obstruction caused by secondary tumors. Surg Oncol. 2006;15(1):29–32.
Reynolds I, Healy P, Macnamara DA. Malignant tumors of small intestine. Surgeon. 2014;12(5):263–70.
Green J, Schlieve CR, Friedrich AK, Baratta K, Ma DH, Min M, et al. Approach to the diagnostic workup and management of small bowel lesions at tertiary care cen¬ter. J Gastrointest Surg. 2018;22(6):1034–42.
Kopacova M, Rejchrt S, Bures J, Tacheci I. Small intesti¬nal tumours. Gastroenterol Res Pract. 2013;2013:702536.
van der Flier LG, Clevers H. Stem cells, self-renewal and differentiation in the intestinal epithelium. Ann Rev Physiol. 2009;71:241–60.
Breedveld A, van Egmond MV. IgA and FcαRI: patholog¬ical roles and therapeutic opportunities. Front Immunol. 2019;10:553.
Negoi I, Paun S, Hostiuc S, Stoica B, Tanase I, Negoi RI, et al. Most small bowel cancers are revealed by a compli¬cation. Einstein. 2015;13(4):500–5.
Kojima Y, Matsumoto F, Mikami Y, Namekata K, Takei M. Metastatic small bowel tumor from descending colon cancer with extensive hematogenous or lymphogenous spread: survey of the Japanese literature. Case Rep Gas¬troenterol. 2010;4(3):340–5.
Pennel DJ, Goergen N, Driver CP. Nonspecific abdomi¬nal pain is a safe diagnosis. J Ped Surg. 2014;49:1602–4.
Sanders DS, Azmy IA, Hurlstone DP. A new insight into non-specific abdominal pain. Ann R Coll Surg Engl. 2006;88(2):92–4.
Cardoso H, Rodrigues J, Marques M, Ribeiro A, Vilas- Boas F, Santos-Antunes J, et al. Malignant small bowel tumors: diagnosis, management and prognosis. Acta Med Port. 2015;28:448–56.
Zhang S, Zheng C, Chen Y, Xu Q, Ma J, Yuan W, et al. Clinicopathologic features, surgical treatments and out¬comes of small bowel tumors: a retrospective study in China. Int J Surg. 2017;43:145–54.
Cheung DY, Choi MG. Current advance in small bowel tumors. Clin Endosc. 2011;44:13–21.