Next journal club - 24th January 2011
Presenter : Dr. Rizal
Meckel’s Diverticulum—A High-Risk Region for Malignancy
in the Ileum
Insights From a Population-Based Epidemiological Study and Implications
in Surgical Management
Pragatheeshwar Thirunavukarasu, MD∗, Magesh Sathaiah, MBBS∗, Shyam Sukumar, MD†,
Christopher J. Bartels, MD∗, Herbert Zeh, III, MD∗, Kenneth K. W. Lee, MD∗, and David L. Bartlett, MD∗
Annals of Surgery Volume 253, Number 2, February 2011
Abstract
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.
