Clinical features and outcomes of bowel perforation in primary pediatric gastrointestinal lymphoma
Jiayu Yan1, Yanlong Duan2,3, Tingting Liu4
1Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nalishi Road, Xicheng District, CN, 100045, Beijing, People's Republic of China.
Insights
Prompt diagnosis and chemotherapy are crucial for primary pediatric gastrointestinal lymphoma (PPGL). Surgery may worsen outcomes for patients with perforation before chemotherapy, while its effect is neutral for those with perforation during treatment.
Area of Science:
- Pediatric Oncology
- Surgical Gastroenterology
- Hematology-Oncology
Background:
- Primary pediatric gastrointestinal lymphoma (PPGL) with bowel perforation presents a complex clinical challenge.
- The role of surgery in managing PPGL with perforation remains controversial, impacting patient prognosis.
Purpose of the Study:
- To evaluate the prognostic impact of surgical intervention in pediatric patients with primary gastrointestinal lymphoma experiencing bowel perforation.
- To compare outcomes for patients with perforation occurring during versus before chemotherapy.
Main Methods:
- Retrospective review of medical records for nine pediatric patients diagnosed with PPGL and bowel perforation between 2010 and 2020.
- Patients were categorized into two groups: perforation during chemotherapy (n=4) and before chemotherapy (n=5).
- Long-term follow-up was conducted via telephone to assess patient survival and recurrence.
Main Results:
- Patients with perforation during chemotherapy, regardless of surgical intervention, survived with regular chemotherapy.
- In contrast, patients with perforation before chemotherapy who underwent surgery experienced high rates of complications and mortality (3/4 died).
- One patient with perforation before chemotherapy, treated conservatively and receiving chemotherapy, survived without recurrence.
Conclusions:
- Prompt diagnosis and timely chemotherapy are key to improving outcomes in PPGL.
- Surgery does not appear to influence prognosis for PPGL patients with perforation during chemotherapy.
- Surgical intervention may adversely affect disease progression in PPGL patients with perforation prior to chemotherapy.
Background:
Whether surgery can improve the prognosis of patients with primary pediatric gastrointestinal lymphoma (PPGL) who experienced bowel perforation remains controversial. This study aimed to evaluate the prognosis of such patients.
Methods:
Nine patients pathologically diagnosed with PPGL who experienced perforation at our center between January 2010 and December 2020 were enrolled and divided into two groups: those with perforation during (n = 4) and before (n = 5) chemotherapy. Their medical records were reviewed, and long-term follow-up was conducted by telephone in February 2021.
Results:
All patients with perforation during chemotherapy were diagnosed with PPGL in the outpatient department. The mean time from outpatient visit to chemotherapy was 17.3 ± 6.1 days. Two patients experienced perforation during the first chemotherapy regimen and received conservative treatment, while the others developed perforation after multiple chemotherapy regimens and underwent surgery. All of the patients received regular chemotherapy and survived for a mean follow-up time of 3.8 ± 1.9 years. No patient with perforation before chemotherapy had a definite diagnosis in the outpatient department. Among these patients, 4 experienced perforation and underwent surgery, of whom 3 developed perforation-related complications and died; the other recurred after chemotherapy. Only the patient who received conservative treatment was diagnosed with PPGL before chemotherapy, received regular chemotherapy, and survived without a recurrence for 1.0 year.
Conclusion:
Prompt diagnosis and chemotherapy improve the prognosis of PPGL. Surgery does not affect the prognosis of patients with perforation during chemotherapy but may accelerate disease progression in patients with perforation before chemotherapy.
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