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Surgical implications of primary gastrointestinal lymphoma of childhood
I D Fleming1, P S Turk, S B Murphy
1Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38101.
Insights
Complete surgical resection improves survival for children with gastrointestinal non-Hodgkin's lymphoma. Early and complete tumor removal, combined with chemotherapy and irradiation, offers the best outcome for pediatric patients.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Hematology-Oncology
Background:
- Non-Hodgkin's lymphoma (NHL) is a significant malignancy in children.
- Gastrointestinal involvement is a common presentation of pediatric NHL.
- The role of surgical intervention in managing pediatric GI NHL requires further elucidation.
Purpose of the Study:
- To review the institutional experience with surgical resection for pediatric gastrointestinal non-Hodgkin's lymphoma.
- To evaluate the impact of surgical management on patient outcomes.
- To determine the efficacy of complete tumor resection in this population.
Main Methods:
- Retrospective review of 58 pediatric patients treated for primary gastrointestinal non-Hodgkin's lymphoma.
- Analysis of surgical approaches: complete resection, partial resection, and biopsy only.
- Correlation of surgical outcomes with adjuvant chemotherapy and irradiation protocols.
Main Results:
- Most tumors were located in the ileocolic region (n=54), with 21 presenting as intussusception.
- Complete surgical resection was achieved in 32 patients.
- A 76% overall survival rate (44/58) was observed, with 31 of 32 patients undergoing complete resection surviving, compared to 13 of 26 with residual disease.
Conclusions:
- Complete surgical resection is a critical component in the management of pediatric gastrointestinal non-Hodgkin's lymphoma.
- Feasible complete tumor removal, alongside standard protocols, significantly enhances survival rates.
- Surgical intervention should be prioritized when possible for optimal pediatric GI NHL management.
Abstract:
Our purpose was to summarize information from a large single institution's experience regarding the role of surgical resection in the management of non-Hodgkin's lymphoma in children and adolescents. Fifty-eight children were treated for primary gastrointestinal non-Hodgkin's lymphoma. The tumors usually presented in the ileocolic region (n = 54). Twenty-one children presented with intussusception. Complete surgical resection of tumor was accomplished in 32 patients, partial resection in 20, and biopsy only in 6. All patients were given lymphoma protocols employing chemotherapy and irradiation. Forty-four (76%) of 58 patients are surviving from 1 year to greater than 20 years from diagnosis. Thirty-one of 32 patients who underwent complete resection followed by protocol management are surviving, compared with 13 of 26 children with residual gross disease. The results indicate that children with primary gastrointestinal non-Hodgkin's lymphoma benefit from complete surgical resection when feasible.