Surgery in (pre)malignant celiac disease

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 43; pp. 12403 - 12409
• Main Authors: van de Water, Jolanda M W, Nijeboer, Petula, de Baaij, Laura R, Zegers, Jessy, Bouma, Gerd, Visser, Otto J, van der Peet, Donald L, Mulder, Chris J J, Meijerink, Wilhelmus J H J
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.11.2015
• Subjects: Aged; Antineoplastic Agents - therapeutic use; associated; Celiac Disease - diagnosis; Celiac Disease - drug therapy; Celiac Disease - mortality; Celiac Disease - surgery; Chemotherapy, Adjuvant; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - mortality; Elective Surgical Procedures; Enteropathy; Enteropathy-Associated T-Cell Lymphoma - diagnosis; Enteropathy-Associated T-Cell Lymphoma - drug therapy; Enteropathy-Associated T-Cell Lymphoma - mortality; Enteropathy-Associated T-Cell Lymphoma - surgery; Female; Humans; Intestinal Neoplasms - diagnosis; Intestinal Neoplasms - drug therapy; Intestinal Neoplasms - mortality; Intestinal Neoplasms - surgery; Kaplan-Meier Estimate; lymphoma;Ulcerative; Male; Middle Aged; Netherlands; Postoperative Complications - etiology; Precancerous Conditions - diagnosis; Precancerous Conditions - drug therapy; Precancerous Conditions - mortality; Precancerous Conditions - surgery; Retrospective Studies; Retrospective Study; Risk Factors; T-cell; Time Factors; Treatment Outcome; Celiac disease; Enteropathy associated T-cell lymphoma; Refractory celiac disease; Ulcerative jejunitis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i43.12403

AIM: To report the outcome of surgery in patients with(pre)malignant conditions of celiac disease(CD) and the impact on survival.METHODS: A total of 40 patients with(pre)malignant conditions of CD,ulcerative jejunitis(n = 5) and enteropathy associated T-cell lymphoma(EATL)(n = 35),who underwent surgery between 2002 and 2013 were retrospectively evaluated. Data on indications,operative procedure,post-operative morbidity and mortali ty,adjuvant therapy and overal l survival(OS) were collected. Eleven patients with EATL who underwent chemotherapy without resection were included as a control group for survival analysis. Patients were followed-up every three months during the first year and at 6-mo intervals thereafter.RESULTS: Mean age at resection was 62 years. The majority of patients(63%) underwent elective laparotomy. Functional stenosis(n = 1 3) and perforation(n = 12) were the major indications for surgery. In 70% of patients radical resection wasperformed. Early postoperative complications,mainly due to leakage or sepsis,occurred in 14/40(35%) of patients. Eight patients required reoperation. More patients who underwent resection in the acute setting(n = 3,20%) died compared to patients treated in the elective setting. With a median follow-up of 20 mo,seven patients(18%) required reoperation due to long-term complications. Significantly more patients who underwent acute surgery could not be treated with adjuvant chemotherapy. Patients who first underwent surgical resection showed significantly better OS than patients who received chemotherapy without resection.CONCLUSION: Although the complication rate is high,the preferred first step of treatment in(pre)malignant CD consists of local resection as early as possible to improve survival.