Portal de Periódicos da CAPES

The role of surgery in abdominal Burkitt's lymphoma

1992; Elsevier BV; Volume: 27; Issue: 2 Linguagem: Inglês

10.1016/0022-3468(92)90319-3

1531-5037

Robert C. Shamberger, Howard J. Weinstein,

Intraperitoneal and Appendiceal Malignancies

The abdomen is the most frequent site of involvement in nonendemic Burkitt's lymphoma (small noncleaved cell). Some authors have proposed a role for extensive surgical resection or "second look" laparotomy in these patients. We retrospectively reviewed our series of 53 patients with Burkitt's lymphoma (1977 to 1990) to assess the role of surgery in their treatment. Patients were 2.5 to 21 years of age (median, 9.5 years) and 44 were males. The primary site of disease was the abdomen (38), head and neck (12), axilla (1), and bone marrow (2). Twenty-four of the 38 patients with abdominal primaries underwent laparotomy. Twelve of these patients presented with acute abdominal symptoms (right lower quadrant pain or intestinal obstruction) and at exploration underwent resection of the primary tumor. Ten of these 12 patients achieved grossly complete excision of tumor (9 had disease limited to the ileocecal area and adjacent mesentery and one had exophytic tumor adherent to the liver, which was excised). Of note, only 1 of these 12 patients had metastatic disease outside of the abdomen. The remaining 12 patients who underwent laparotomy had an incisional biopsy performed. Of the 14 patients who did not have a laparotomy, the diagnosis was made by bone marrow biopsy (6), and/or cytology of pleural fluid or ascites (6), lymph node biopsy (1), testicular biopsy (1), tibial biopsy (1), and percutaneous biopsy (1). Murphy staging for these 38 patients was: stage II (10), stage III (19), stage IV (5), and B cell acute lymphoblastic leukemia (ALL) (4). All patients received cyclophosphamide-containing combination chemotherapy regimens and stage III/IV/B cell ALL patients received central nervous system (CNS) prophylaxis. Between 1977 and 1982, 5 patients with stage II received whole abdominal irradiation. Patient survival without recurrent disease corresponded with stage at presentation: 9 of 10 stage II, 8 of 19 stage III, 1 of 5 stage IV, and 2 of 4 B cell ALL patients (follow-up of survivors: median, 8.3 years; range, 9 months to 11 years). In only 3 patients was a second look procedure performed because of questionable residual local disease. One of those 3 patients had viable tumor and he suffered a CNS relapse shortly after surgery. Only 1 patient in the entire group had an isolated recurrence in the abdomen. All of the other 12 patients who relapsed had tumor involving either CNS (5), bone marrow (3), testes (4), liver (2), and/or thorax (3). Four of these 12 also had local abdominal recurrence. We conclude that exploratory surgery for the purpose of resection of the primary tumor is only justified for patients with limited ileocecal and mesenteric involvement who are likely to present with signs of intestinal obstruction or abdominal pain. These patients have a high likelihood of disease-free survival probably due to limited disease at presentation. Extensive surgical procedures in patients with more advanced abdominal involvement will often result in only partial resections as metastatic disease is frequently present. Persistent or recurrent local abdominal disease following chemotherapy are infrequent events limiting the role for delayed primary or "second look" procedures.