Surgical treatment of primitive gastro-intestinal lymphomas: a systematic review

Abstract

Primitive Gastrointestinal Lymphomas (PGIL) are uncommon tumours, although time-trend analyses have demonstrated an increase. The role of surgery in the management of lymphoproliferative diseases has changed over the past 40 years. Nowadays their management is centred on systemic treatments as chemo-/radio- therapy. Surgery is restricted to very selected indications, always discussed in a multidisciplinary setting. The aim of this systematic review is to evaluate the actual role of surgery in the treatment of PGIL.A systematic review of literature was conducted according to the recommendations of The Cochrane Collaboration. Main outcomes analysed were overall survival (OS) and disease free survival (DFS).There are currently 1 RCT and 4 non-randomised prospective controlled studies comparing surgical versus medical treatment for PGIL. Seven hundred and one patients were analysed, divided into two groups: 318 who underwent to surgery alone or associated with chemotherapy and/or radiotherapy (surgical group) versus 383 who were treated with chemotherapy and/or radiotherapy (medical group).Despite the OS at 10 years between surgical and medical groups did not show relevant differences, the DFS was significantly better in the medical group (P = 0.00001). Accordingly a trend was noticed in the recurrence rate, which was lower in the medical group (6.06 vs. 8.57%); and an higher mortality was revealed in the surgical group (4.51% vs. 1.50%).The chemotherapy confirms its primary role in the management of PGIL as part of systemic treatment in the medical group. Surgery remains the treatment of choice in case of PGIL acutely complicated, although there is no evidence in literature regarding the utility of preventive surgery.

Primary diffuse large B‐cell lymphoma presenting as acute appendicitis: A report of 2 cases and a literature review

“…Several studies have shown no differences in survival for patients treated with chemotherapy and/or radiation therapy alone vs surgery plus chemotherapy and/or radiation therapy . A meta‐analysis of five studies containing a total of 701 patients with PGINHL revealed no differences in OS at 10 years between patients treated with chemotherapy and/or radiation therapy compared to patients treated surgically (HR 0.61, 95% CI 0.26‐1.41, P = .25); however, patients treated with chemotherapy and/or radiation therapy alone had superior disease‐free survival (OR 0.17, 95% CI 0.08‐0.37, P < .00001) …”

“…7,[9][10][11][12][13][14] A meta-analysis of five studies containing a total of 701 patients with PGINHL revealed no differences in OS at 10 years between patients treated with chemotherapy and/or radiation therapy compared to patients treated surgically (HR 0.61, 95% CI 0.26-1.41, P = .25); however, patients treated with chemotherapy and/or radiation therapy alone had superior disease-free survival (OR 0.17, 95% CI 0.08-0.37, P < .00001). 15 Several studies have shown a survival benefit for surgery and chemotherapy/radiation therapy compared to chemotherapy and/or radiation therapy alone. [16][17][18][19][20][21] The largest of these trials was a retrospective study of 345 patients with GI DLBCL.…”

Addition of Rituximab to Chemotherapy Reduced the Rate of Surgery for Gastric-DLBCL Without Increasing Early Mortality

“…The literature also showed a decrease in the role of primary surgery for primary gastric NHL. It has been shown that surgery should be reserved for the treatment of patients who present with disease complications, such as bleeding or perforation, due to the innate morbidity of surgery (15)(16)(17)(18)(19). Our study was designed to explore whether the introduction of rituximab and the decreasing rates of primary surgery influenced early mortality in patients with gastric DLBCL.…”

Treatment of gastric marginal zone B‐cell lymphoma of the mucosa‐associated lymphoid tissue with rituximab, cyclophosphamide, vincristine and prednisone

“…Although surgery can clearly result in excellent survival for patients with localized disease, it is associated with both short-term and long-term morbidity. Therefore, surgical treatment is generally reserved for the treatment of complications, such as occlusion, bleeding or perforation [17]. In cases of localized disease, excellent control can be also obtained with radiation therapy.…”