Limitations of surgery in intraabdominal Burkitt's lymphoma in children

Abstract

The role of surgery in intraabdominal Burkitt's lymphoma is a controversial subject, and different views are expressed. In the authors' institution, 41 children (30 boys and 11 girls) have been treated who had intraabdominal Burkitt's lymphoma. A study was undertaken to assess the limitations of surgery in the treatment of intraabdominal Burkitt's lymphoma. An uniform policy was made to resect the tumor if possible or to debulk tumor irrespective of the spread of disease, and if this was not possible to perform only a biopsy. Thirty-nine children had laparotomy and various operative procedures, and in 2 children no laparotomy was performed, but tissue was obtained for histopathologic examination from cervical lymph nodes and jaw. Twelve children underwent complete resection of the intraabdominal tumor. There were no deaths in this group, and 10 of 12 children are long-term survivors. In 15 patients, debulking of the tumor was carried out. In 4, the tumor had perforated the bowel and caused widespread intraperitoneal deposits and sepsis. There were 3 deaths during the immediate postoperative period, 2 caused by peritoneal sepsis and 1 caused by surgical trauma in advanced disease. Three of 15 patients have survived for more than 2 years. Lastly, in 14 children only a biopsy was performed. Notable features in this group were that 6 patients had extraabdominal disease and another 6 presented initially with features of intestinal obstruction. In the latter group, intestinal bypass procedures were performed but no debulking was attempted. Five of 14 patients died after surgery, whereas 3 were long-term survivors. Patients were administered a chemotherapy regimen consisting of cyclophosphamide, vincristine, Adriamycin, and prednisolone. None of the deaths in this series were attributable to tumor lysis syndrome. Our results confirm that when Burkitt's tumor was localized or mobile, resection resulted in a good outcome, but debulking in the presence of wide-spread disease did not enhance survival. In patients with widespread disease due to advanced tumor, it is desirable to limit the surgery to tissue biopsy only.