Surgery in management of paediatric abdominal lymphoma:A traditional tool-revisited

Abstract

Background: The abdomen is one of the most frequent sites for lymphoma in children. The role of surgery has been limited to intra-abdominal respectable tumours or as a diagnostic procedure in case of disseminated disease. Laparotomy without total excision of the tumour does not improve survival; moreover, it may cause complications and delays initiation of chemotherapy. Aim of the work: This study was undertaken to assess the role of surgery in the management of children and adolescents presenting with intra-abdomina/lymphoma in order to create certain criteria to select the proper surgical modality for managing those patients. Patients and methods: This retrospective, descriptive study was done on 33 patients of abdominal lymphoma over a period of seven years from 2000 to 2007. Patients' files were reviewed regarding the full clinical examinations, laboratory and radiological investigations as well as surgical and diagnostic procedures. Collected data were tabulated and statistically analyzed using SPSS program package. Results: Patients' ages ranged from 2.5 to 16 years with a mean of6.7. They were 18females and 15 males at FIM ratio 1.2: 1. In those patients who underwent surgery; seventeen (51.5%) presented with emergency complaints, 10 patients (30%) with acute abdominal pain and 7 patients (21.5%) with intestinal obstruction with surgical excision of the tumour mass. In the remaining 16 patients, 9 had huge pelvi-abdominal massesand 7 had generalized lymphadenopathy where the intra-abdominal involvement was discovered following further investigation. Conclusion: Surgery still has a role in treatment of lymphoma whether non Hodgkin or Hodgkin's as complete resection does improve the survival rate, however, in disseminated metastatic disease, aggressive debulking of the tumour should be avoided as chemotherapy is to be instituted primarily. Surgical resection does not cause significant change in morbidity or mortality.