title: Surgery in (pre)malignant celiac disease.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Jolanda M W
authors.initials: JM
authors.lastname: van de Water
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Petula
authors.initials: P
authors.lastname: Nijeboer
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Laura R
authors.initials: LR
authors.lastname: de Baaij
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Jessy
authors.initials: J
authors.lastname: Zegers
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Gerd
authors.initials: G
authors.lastname: Bouma
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Otto J
authors.initials: OJ
authors.lastname: Visser
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Donald L
authors.initials: DL
authors.lastname: van der Peet
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Chris J J
authors.initials: CJ
authors.lastname: Mulder
authors.affiliation: Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
authors.forename: Wilhelmus J H J
authors.initials: WJ
authors.lastname: Meijerink
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002446:Celiac Disease / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D058527:Enteropathy-Associated T-Cell Lymphoma / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000209:etiology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: Celiac disease; Enteropathy associated T-cell lymphoma; Refractory celiac disease; Ulcerative jejunitis