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Primary Colonic Lymphoma

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Surgical resection of primary colonic lymphoma can be an important therapeutic tool. We perormed a nonrandomized retrospective descriptive study at the University hospital tertiary care center. From January 1990 to June 2002, a total of 15 patients with primary colonic lymphoma were identified from the tumor registry at University of Alabama at Birmingham and retrospectively reviewed under Institutional Review Board approved protocol. Demographic data, clinical features, treatment method (surgery and/or chemotherapy), recurrence rate, and survival were analyzed. The results are presented as mean ± standard deviation or median and range. Differences in survival were evaluated by the log-rank test and the interval of disease-free survival was calculated using the Kaplan-Meier method. A P value of <0.05 was considered statistically significant. Main outcome measures included surgical results, morbidity, mortality, and recurrencerate. Mean age was 51.5 years (standard deviation 16.4), 33 per cent were male and 67 per cent were female. Presenting symptoms were diarrhea (53.5%), lower gastrointestinal bleeding (13.3%), and nausea and vomiting (46.7%) secondary to low-grade obstruction. Concomitant colorectal disease was present in one patient with ulcerative colitis. Preoperative diagnosis of lymphoma was made in 13 patients (87%) with colonoscopy and biopsy. CT scan was performed in all patients; and none had radiographic evidence of systemic extension. Only one patient had a history of lymphoproliferative disease and exposure to radiation. The most common disease location was the cecum (60%), followed by the right colon (27%), and the sigmoid colon (13%). The mean lactic dehydrogenase (LDH) value was 214.9 u/L (range 129–309). Thirty-three per cent of the patients had an LDH value that was above the upper normal limit. LDH returned to normal after treatment in all patients. Operations performed consisted of right hemicolectomy (13), total proctocolectomy with ileal J J-pouch (1), and sigmoid colectomy (1). Eighty-seven per cent had negative margins at the time of operation. Twelve patients received postoperative chemotherapy (80%). According to the clinical classification of primary non-Hodgkin lymphoma (NHL) of the gastrointestinal tract (Lugano, 1993) all patients corresponded to stage IE. Mean hospital stay was 6.4 days (range 3–26). There was no surgical mortality and the morbidity rate was 20 per cent (3 patients). One patient had a systemic recurrence (7%) approximately 4 months after surgical resection. Mean follow-up was 31 months (median 2–73). Surgical resection of localized, primary colonic lymphoma provides excellent local disease control and should be considered a primary treatment option. The role of chemotherapy remains controversial depending on the grade, stage, and extension of residual disease.
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Document Type: Research Article

Affiliations: 1: From theDepartment of Surgery, División of Colorectal Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubirán, Mexico City, Mexico and the Departments of 2: Surgical Oncology and 3: Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama

Publication date: March 1, 2008

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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