Surgical management of primary colonic lymphoma: Big data for a rare problem

Abstract

Background and Objectives Primary colonic lymphoma (PCL) is rare, heterogeneous, and presents a therapeutic challenge for surgeons. Optimal treatment strategies are difficult to standardize, leading to variation in therapy. Our objective was to describe the patient characteristics, short‐term outcomes, and five‐year survival of patients undergoing nonpalliative surgery for PCL. Methods We performed a retrospective cohort analysis in the National Cancer Database. Included patients underwent surgery for PCL between 2004 to 2014. Patients with metastases and palliative operations were excluded. Univariate predictors of overall survival were analyzed using multivariable Cox proportional hazard analysis. Results We identified 2153 patients. Median patient age was 68. Diffuse large B‐cell lymphoma accounted for 57% of tumors. 30‐ and 90‐Day mortality were high (5.6% and 11.1%, respectively). Thirty‐nine percent of patients received adjuvant chemotherapy. For patients surviving 90 days, 5‐year survival was 71.8%. Chemotherapy improved survival (surgery+chemo, 75.4% vs surgery, 68.6%; P = .01). Adjuvant chemotherapy was associated with overall survival after controlling for age, comorbidity, and lymphoma subtype (HR 1.27; 95% CI, 1.07‐1.51; P = .01). Conclusions Patients undergoing surgery for PCL have high rates of margin positivity and high short‐term mortality. Chemotherapy improves survival, but <50% receive it. These data suggest the opportunity for improvement of care in patients with PCL.

Case Report on Diffuse Large B-Cell Non-Hodgkin Lymphoma with a Spontaneous Bowel Perforation

“…The patient in our case presented with a perforation and was offered resection followed by chemotherapy. A recent study by Lu et al found that chemotherapy in combination with surgical resection is associated with better survival outcomes in nonmetastatic disease [16], and Maguire et al found that there are better survival outcomes in patients who receive chemotherapy, but the overall survival depends on age, subtypes of lymphoma, and comorbid conditions [17]. There are no clear indications for surgery without complications; however, surgery offers a definitive diagnosis, alleviates symptoms, and can prevent tumor perforation while receiving chemotherapy [17].…”

Predictors and Long-Term Outcomes for Diffuse Large B-Cell Lymphoma (DLBCL) Patients Undergoing Surgery Prior to Systemic Therapy: A Nationwide Analysis

“…A study involving PCNSL included 3342 patients collected from the Surveillance, Epidemiology, and End Results (SEER) database and demonstrated improved survival among patients who underwent surgery. However, further survival analyses demonstrated a benefit from surgery only among early‐stage patients [ 18 ].…”

“…An early report from the University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States, on this subject showed improved survival was observed in patients with stage I-IE and II-IIE aggressive lymphoma who underwent debulking surgery when the tumor was deemed resectable [ 18 ]. In a propensity-matched gastric DLBCL SEER study, The five-year cancer-specific survival rate of the surgical group was significantly higher than that of the conservative treatment group.…”