Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12403
Peer-review started: December 30, 2015
First decision: January 22, 2015
Revised: March 29, 2015
Accepted: June 9, 2015
Article in press: June 10, 2015
Published online: November 21, 2015
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 mortality, adjuvant therapy and overall 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 = 13) and perforation (n = 12) were the major indications for surgery. In 70% of patients radical resection was performed. 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.
Core tip: A small percentage of patients with celiac disease develop (pre)malignant conditions including enteropathy associated T-cell lymphoma. No standardized treatment has been established. Surgery is indicated to relieve clinical symptoms or prevent perforation during chemotherapy. Although the frequency of early- and late post-operative complications is high, local resection is the preferred first step of treatment. Resection is preferred as early as possible after diagnosis since treatment-related mortality seems to rise in the acute setting. Early diagnosis is of utmost importance as elective surgical resection might lower the risk of post-operative mortality and improve overall survival.