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文献考察１）：小腸腫瘍
【小腸腫瘍 分類と画像所見】 小腸腫瘍 最近5年間(1995〜1999)の本邦報告例の集計
Author：八尾恒良(福岡大学医学部附属筑紫病院 消化器科), 八尾建史, 真武弘明, 古川敬一, 永江隆, 本村明,
菊池陽介, 高木靖寛, 嶋津剛典, 頼岡誠, 久部高司, 八尾哲史, 西村拓, 蒲池紫乃, 竹下宗範, 永本和洋, 諸隈一平,櫻井俊弘, 松井敏幸
Source：胃と腸(0536-2180)36巻7号 Page871-881(2001.06)
Abstract：過去5年間の小腸原発性腫瘍の報告例(約480例)を抽出・集計し,20年前の集計と比較した.組織型別頻度は, 癌157例(32.6%), 悪性リンパ腫146例(30.4%), 平滑筋肉腫140例(29.1%), 悪性神経原性腫瘍8例(1.7%), カルチノイド8例(1.7%), その他22例が続き, 組織別悪性腫瘍の明らかな増加傾向はなかった.病変の存在部位は, 良・悪性とも, Treitz靭帯およびBauhin弁より離れた部位で多い傾向にあった.消化管間質性腫瘍における免疫染色が行われた報告は, 1998年度以降では, 約半数の24例(53.3%)であった.前回の集計と比較すると,平滑筋腫の頻度がやや高率であったが, その他,腫瘍の大きさ, 臨床症状などに大差はなかった．
追記：癌は56.7%が空腸に，43.3%が回腸に存在した(1:0.8)．空腸に存在したものの中では, Treitz敬帯より60cm以内が83.9%を占め, 回腸に存在するものではBauhin弁より40cm以内に位置するものが72.2%, 60cm以内が83.3%を占めた．すなわち癌は上部空腸, またはBauhin弁近傍の回腸が好発部位と考えられた．
文献考察２）：小腸悪性腫瘍129例中癌は33％を占め，5年生存率は37％
Arch Surg. 2002 May;137(5):564-70; discussion 570-1.
Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management.
Talamonti MS, Goetz LH, Rao S, Joehl RJ.
HYPOTHESIS: This study was done to review the clinical presentation, surgical management, pathologic features, and prognostic factors for primary small-bowel cancers. DESIGN: Retrospective case series. SETTING: Tertiary care, university hospital. PATIENTS: One hundred twenty-nine patients were surgically treated between January 1, 1977, and December 31, 2000. There were 73 men and 56 women, with a median age of 55 years (age range, 19-82 years). Median follow-up was 36 months. MAIN OUTCOME MEASURES: Presenting symptoms and signs, operations performed, and surgical pathologic features were analyzed and survival curves were generated. RESULTS: Clinical findings included abdominal pain (63%), vomiting (48%), weight loss (44%), and gastrointestinal tract bleeding (23%). The distribution of tumors by histological features was as follows: adenocarcinoma (33%), carcinoid tumor (29%), lymphoma (19%), and sarcoma (19%). Cumulative 5-year survival rate was 37% in the adenocarcinoma group, 64% in the carcinoid tumor group, 29% in the lymphoma group, and 22% in the sarcoma group. Significant prognostic predictors of overall survival for the entire cohort and for each tumor subtype included complete resection and American Joint Committee on Cancer tumor stage (P<.05 patient age tumor location histological grade and use of chemotherapy radiation therapy did not significantly influence survival. curative resections were accomplished in patients with a median survival months compared undergoing incomplete or palliative adjacent organ resection was required the potentially resections. time to recurrence months. twenty-one developed associated primary cancers. conclusions: aggressive surgical an attempt achieve complete removal seems warranted. despite high-stage tumors remain at risk for recurrence.pmid:>
文献考察３）：小腸癌217例．部位は十二指腸52％，空腸25％，回腸13％．5年生存率は26％．
Cancer. 2004 Aug 1;101(3):518-26.
Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients.
Dabaja BS, Suki D, Pro B, Bonnen M, Ajani J.
BACKGROUND: Primary adenocarcinoma of the small bowel is a rare neoplasm, and to the authors' knowledge, few studies to date have addressed the topic. METHODS: In the current study, the records of 217 patients with small bowel adenocarcinoma were reviewed retrospectively for the presentation, prognostic factors, treatment modalities, and outcome. RESULTS: The median age of the patients was 55 years and there were 133 (61%) males. Tumors originated in the duodenum in 113 (52%) patients, the jejunum in 54 (25%) patients, the ileum in 28 (13%) patients, and in nonspecified sites in 22 (10%) patients. Patients with proximal tumors were diagnosed for the most part using endoscopy (i.e., 46 of 108 [43%]), whereas laparotomy enabled diagnosis in 16 of 28 (57%) patients with distal tumors. Based on TNM staging, 9 (4%) patients had Stage I disease, 43 (20%) patients had Stage II disease, 86 (39%) patients had Stage III disease, and 75 (35%) patients had Stage IV disease. The liver was the most common site of metastasis in 44 (59%) patients. Cancer-directed surgery was performed in 146 (67 %) patients, including the Whipple procedure in 36 patients (17%). The median overall survival time was 20 months. The 5-year overall survival rate was 26%. Cancer-directed surgery, early-stage disease, and lymph node involvement ratio were significantly associated with overall survival by univariate analysis. However, only cancer-directed surgery and lymph node involvement ratio were independent predictors of overall survival in a multivariate analysis (adjusted rate ratio = 0.14; 95% confidence interval [95% CI], 0.04-0.46; P = 0.001 and adjusted rate ratio = 0.25; 95% CI, 0.12-0.53; P
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