Abdominal Lymphoma - the Place for Surgery

Gastrointestinal lymphoma (GIL) is rare but may be cured by surgery and chemotherapy. Because symptoms frequently mimic common abdominal conditions, presentation is often to a surgeon. Fiftyfive patients with GIL were treated between 1975 and 1984: all underwent operations before the correct diagnosis was made, 22 (40%) as emergencies. Misdiagnosis in 23 (42%) led to a delay in correct treatment of ≥ 6 months from the start of symptoms: in 17 (31%) the delay was ≥ one year. Endoscopy and radiology were inaccurate and suggested peptic ulceration, Crohn's disease or irritable bowel syndrome. The site of disease was usually stomach and duodenum (26, 47%) or ileum and jejunum (29, 53%). The extent of surgical resection was associated with survival at ≥3 years - in 16 (29%) who underwent ‘complete resection’ 14 survived, but only one of 28 survived when the operation was limited to diagnostic biopsy (P < 0.0001). Most deaths occurred within one year of operation, commonlyfrom perforation or haematemesis from residual mural disease during chemotherapy. In 5 of 11 patients who had biopsy only, CT scans suggested localized disease, and ‘complete resection’ was achieved at a second laparotomy. Complete resection should be attempted wherever possible before chemotherapy. The place for surgeons with experience is clearly central to the management of this disease.