TY - JOUR
T1 - Meckel's diverticulum-A high-risk region for malignancy in the ileum
T2 - Insights from a population-based epidemiological study and implications in surgical management
AU - Thirunavukarasu, Pragatheeshwar
AU - Sathaiah, Magesh
AU - Sukumar, Shyam
AU - Bartels, Christopher J.
AU - Zeh, Herbert
AU - Lee, Kenneth K.W.
AU - Bartlett, David L.
PY - 2011/2
Y1 - 2011/2
N2 - Background: Surgical management of incidental Meckel's diverticulum (MD) is a highly debated controversial issue that has never been discussed from the oncological standpoint. Objective: To describe the epidemiology and risk of Meckel's diverticulum cancer (MDC) and compare it with other ileal malignancies. Methods: Data were obtained from 163 cases of MDC and 6214 cases of non-Meckelian ileal cancer, between 1973 and 2006, from the Surveillance, Epidemiology, and End Results database. Results: Mean annual incidence was 1.44 (± 1.12) per 10 million population, with a 5-fold increase in the last few decades. Incidence increases with age, with a mean age at diagnosis of 60.6 (±15.1) years. Adjusted risk of cancer in the MD was at least 70 times higher than any other ileal site. Disease was localized in 67% at presentation and malignant carcinoids constituted the major histologic type (77%). One-third of patients have had lifetime occurrence of other malignancies and in 13% of these patients, MDC was the first malignancy. Median tumor size was 7 mm. Median overall survival was 173 months (95% confidence interval [CI], 124-221 months), with 1- and 5- year relative survival rates of 85.8% (95% CI, 76.9%-91.4%) and 75.8% (95% CI, 64.9%-83.8%), respectively. Cox proportional hazards model revealed that age, histologic type, and metastatic disease were independent factors affecting survival. Conclusions: MD is a "hot-spot" or high-risk area for cancer in the ileum. With risk that increases with age and high possibility of curative resection with negligible operative mortality, incidental MD is best treated with resection.
AB - Background: Surgical management of incidental Meckel's diverticulum (MD) is a highly debated controversial issue that has never been discussed from the oncological standpoint. Objective: To describe the epidemiology and risk of Meckel's diverticulum cancer (MDC) and compare it with other ileal malignancies. Methods: Data were obtained from 163 cases of MDC and 6214 cases of non-Meckelian ileal cancer, between 1973 and 2006, from the Surveillance, Epidemiology, and End Results database. Results: Mean annual incidence was 1.44 (± 1.12) per 10 million population, with a 5-fold increase in the last few decades. Incidence increases with age, with a mean age at diagnosis of 60.6 (±15.1) years. Adjusted risk of cancer in the MD was at least 70 times higher than any other ileal site. Disease was localized in 67% at presentation and malignant carcinoids constituted the major histologic type (77%). One-third of patients have had lifetime occurrence of other malignancies and in 13% of these patients, MDC was the first malignancy. Median tumor size was 7 mm. Median overall survival was 173 months (95% confidence interval [CI], 124-221 months), with 1- and 5- year relative survival rates of 85.8% (95% CI, 76.9%-91.4%) and 75.8% (95% CI, 64.9%-83.8%), respectively. Cox proportional hazards model revealed that age, histologic type, and metastatic disease were independent factors affecting survival. Conclusions: MD is a "hot-spot" or high-risk area for cancer in the ileum. With risk that increases with age and high possibility of curative resection with negligible operative mortality, incidental MD is best treated with resection.
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U2 - 10.1097/SLA.0b013e3181ef488d
DO - 10.1097/SLA.0b013e3181ef488d
M3 - Article
C2 - 21135700
AN - SCOPUS:79151484744
SN - 0003-4932
VL - 253
SP - 223
EP - 230
JO - Annals of Surgery
JF - Annals of Surgery
IS - 2
ER -