Surgical Resection for Primary Rectal Lymphoma: Support for Local Excision?

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Primary rectal lymphoma is a rare and diverse malignancy with limited treatment guidance.
• This study presents the largest cohort of patients undergoing non-palliative surgery for rectal lymphoma.
• The rarity of this condition necessitates further data to inform treatment strategies and patient counseling.

Purpose of the Study:

• To compare overall survival between local resection (LR) and radical resection (RR) for primary rectal lymphoma.
• To analyze factors influencing outcomes in patients undergoing surgical resection for rectal lymphoma.
• To provide evidence-based recommendations for surgical approaches in primary rectal lymphoma.

Main Methods:

• A retrospective analysis of the National Cancer Data Base (2004-2014) for resected primary rectal lymphoma.
• Exclusion of patients with stage IV disease or those undergoing palliative surgery.
• Categorization by resection approach (LR vs. RR) and analysis using Cox proportional hazard models.

Main Results:

• 233 patients were identified; 87% underwent LR.
• No significant difference in R0 resection rates between LR and RR (38% vs. 58%, P=0.07).
• Five-year overall survival was 79% with no significant difference based on surgical approach (LR: 81% vs. RR: 56%, P=0.06). Multivariable analysis confirmed no association.

Conclusions:

• Surgical resection for primary rectal lymphoma is infrequent.
• The findings support considering local resection (LR) when appropriate.
• There is a lack of convincing survival benefit for radical surgery or achieving R0 resection in rectal lymphoma.