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Surgical Management of Small Bowel Lymphoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Primary small bowel non-Hodgkin’s lymphoma is a rare disease representing 2% of small intestine malignancies. There is limited data delineating the optimal treatment for these heterogeneous tumors. We aim to examine relationships between different treatment modalities and surgical outcomes in patients with small bowel lymphoma.

Materials and Methods

Patients diagnosed with stage I–III small bowel lymphoma in 2004–2015 who underwent surgery were identified in the National Cancer Database. Two cohorts were created based on systemic chemotherapy treatment status. The primary outcome was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival.

Results

2283 patients met inclusion criteria Of these patients, 826 patients (36%) underwent surgical resection alone, and 1457 patients (64%) underwent resection with systemic chemotherapy. Chemotherapy was associated with improved overall survival in unadjusted (5-year overall survival, 55% versus 70%) and adjusted analysis (HR 0.54, 95% CI 0.47–0.63, p < 0.001).

Discussion

Patients with small bowel lymphoma have a low five-year overall survival after surgery. Chemotherapy is associated with improved survival, although one third of patients do not receive this therapy. Several other clinical factors are identified that are also associated with overall survival, including histology subtype, margin status, age, and medical comorbidities. This information can help with prognostication and potentially aid in treatment decision-making.

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Notes

  1. Academic cancer programs: facilities that participate in post-graduate medical education in four or more areas, including internal medicine and general surgery. Community cancer programs (CCP): facilities which see between 100 and 500 cancer diagnoses annually and offer access to a full range of diagnostic and therapeutic options. Comprehensive community cancer programs (CCCP): similar to CCPs; however, they see over 500 cancer diagnoses annually. Integrated network cancer programs (INCP): facilities that are part of a joint venture with multiple facilities providing integrated cancer care with full services.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Pamela W. Lu, Adam C. Fields, James Yoo, Jennifer Irani, Joel E. Goldberg, Ronald Bleday & Nelya Melnitchouk

  2. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Pamela W. Lu & Nelya Melnitchouk

Authors
  1. Pamela W. Lu
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  2. Adam C. Fields
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  3. James Yoo
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  4. Jennifer Irani
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  5. Joel E. Goldberg
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  6. Ronald Bleday
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  7. Nelya Melnitchouk
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All authors had substantial contributions to design of work, drafted work, made final approval, and agreed to be accountable for all aspects of the work.

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Correspondence to Pamela W. Lu or Nelya Melnitchouk.

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The authors declared no conflict of interest.

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Lu, P.W., Fields, A.C., Yoo, J. et al. Surgical Management of Small Bowel Lymphoma. J Gastrointest Surg 25, 757–765 (2021). https://doi.org/10.1007/s11605-020-04730-3

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  • DOI: https://doi.org/10.1007/s11605-020-04730-3

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