ROLE OF SURGERY IN THE MANAGEMENT OF PRIMARY LYMPHOMA OF THE GASTROINTESTINAL-TRACT

The role of surgery in the management of primary gastrointestinal lymp homa remains controversial. We retrospectively reviewed the management and outcome of 107 patients with the diagnosis of gastrointestinal ly mphoma treated at the UCLA Medical Center during the period 1956-1990. Sixty-four patients underwent surgical exploration at the UCLA Medica l Center; 35 of these underwent resection for cure. Sixteen of these 3 5 patients received no postoperative adjuvant therapy. Twenty-nine pat ients underwent palliative or ''noncurative'' resection. There were fi ve postoperative deaths (mortality rate 8%). The overall morbidity rat e was 48%. There were 3 perforations in a total of 53 patients receivi ng multiagent chemotherapy Five-year actuarial survival was as follows : 59% for curative resection alone, 51% for curative resection plus ad juvant therapy, and 28% for ''noncurative'' resection (P < 0.05). Mult ivariate analysis revealed that stage of disease (P < 0.01) and resect ion for cure (P < 0.05) were independent predictors of survival. These results suggest that patients undergoing resection for cure have impr oved survival. The apparent low risk of perforation during chemotherap y, along with the considerable risk of morbidity and mortality associa ted with operation, suggests that a policy of debulking large tumors p rior to chemotherapy is unwarranted. (C) 1996 Wiley-Liss, Inc.