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Gastrointestinal and oncologic outcomes of pediatric gastrointestinal lymphoma following upfront resection or biopsy of bowel masses

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Abstract

Purpose

Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass.

Methods

We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups.

Results

Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery—10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p < 0.001). Three resection patients were surgically down-staged. Second surgeries were required in 30% and 40% of resected and biopsied patients, respectively, at median 4.6 months. Survival was similar in both groups, but better in patients on LMB96 protocol and stage II/III disease.

Conclusions

Children with upfront attempted resection had low rates of surgical down-staging, greater delay in chemotherapy initiation, but fewer gastrointestinal complications and subsequent surgeries than biopsies. Survival was similar regardless of upfront surgery, likely reflecting beneficial effects of newer protocols.

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Acknowledgements

The authors thank Ms Tan Sheng Hui, VIVA-KKH Paediatric Brain and Solid Tumour Programme; Ms Jessica HX Lim, Ms Germaine Liew, Ms Jillian Teo, and A/Prof Chan Mei Yoke, Singapore Childhood Cancer Registry; Ms Candy Choo, Dr Shireen A Nah and Dr Chen Yong, Department of Paediatric Surgery, KK Women’s and Children’s Hospital, for research administrative support.

Funding

This work was supported by the VIVA Foundation for Children with Cancer [VIVA-KKH Paediatric Brain and Solid Tumour Programme] and Children’s Cancer Foundation [Singapore Childhood Cancer Registry].

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Authors and Affiliations

  1. Department of Paediatric Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Mohd Yusran Othman, Huma Faiz Halepota, Yun Le Linn, York Tien Lee & Amos H. P. Loh

  2. Department of Pediatric Surgery, Hospital Tunku Azizah (Women’s and Children’s Hospital), Jalan Raja Muda Abdul Aziz, Kampung Baru, 50300, Kuala Lumpur, Malaysia

    Mohd Yusran Othman

  3. Department of Pediatric General Surgery, Indus Hospital, Plot C-76, Sector 31/5, Karachi, Pakistan

    Huma Faiz Halepota

  4. Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore

    York Tien Lee, Kenneth T. E. Chang, Summaiyya Hanum Ahamed, Joyce C. M. Lam, Rajat Bhattacharyya, Ah Moy Tan & Amos H. P. Loh

  5. VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    York Tien Lee, Kenneth T. E. Chang, Joyce C. M. Lam, Rajat Bhattacharyya, Ah Moy Tan & Amos H. P. Loh

  6. Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Kenneth T. E. Chang

  7. Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Summaiyya Hanum Ahamed

  8. Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Joyce C. M. Lam, Rajat Bhattacharyya & Ah Moy Tan

Authors
  1. Mohd Yusran Othman
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  2. Huma Faiz Halepota
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  3. Yun Le Linn
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  4. York Tien Lee
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  7. Joyce C. M. Lam
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  9. Ah Moy Tan
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  10. Amos H. P. Loh
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Contributions

Conceptualization: MYO, HFH, AHPL; methodology: MYO, HFH, AHPL; formal analysis and investigation: MYO, HFH, YLL, YTL, KTEC, SHA; writing—original draft preparation: MYO; writing—review and editing: KTEC, SHA, JCML, RB, AMT; funding acquisition: AHPL; resources: AMT; supervision: AHPL.

Corresponding author

Correspondence to Amos H. P. Loh.

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Othman, M.Y., Halepota, H.F., Le Linn, Y. et al. Gastrointestinal and oncologic outcomes of pediatric gastrointestinal lymphoma following upfront resection or biopsy of bowel masses. Pediatr Surg Int 37, 1049–1059 (2021). https://doi.org/10.1007/s00383-021-04915-0

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  • DOI: https://doi.org/10.1007/s00383-021-04915-0

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