Meckel's diverticulum--a high-risk region for malignancy in the ileum. Insights from a population-based epidemiological study and implications in surgical management.
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.
Department of Surgery, University of Pittsburgh, UPMC Cancer Pavilion, 5150 Centre Avenue, Pittsburgh, PA 15232, USA.
Pragatheeshwar
P
Thirunavukarasu
Magesh
M
Sathaiah
Shyam
S
Sukumar
Christopher J
CJ
Bartels
Herbert
H
Zeh
Kenneth K W
KK
Lee
David L
DL
Bartlett
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology; D017677:Age Distribution; D000368:Aged; D002276:Carcinoid Tumor / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015994:Incidence; D008297:Male; D008467:Meckel Diverticulum / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D015995:Prevalence; D018426:SEER Program; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology