Emergency presentation of intestinal lymphoma
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Abstract
PURPOSE: The aim of the present study was to evaluate the clinical features, management and outcome of patients submitted to emergency surgery because of intestinal lymphoma.
METHODS: A consecutive series of fourteen patients with gastrointestinal tract lymphoma referred for emergency surgery between March 2006 and May 2010 was retrospectively analyzed.
RESULTS: Patients including 9 males (64.2%) and 5 females (35.7%). The mean age of male and female was 55.4 + 21.2 and 78.4 + 9.0 respectively. The difference was statistically significant (p <0.04). Ileum was the most common location (13 cases, 86.6%) and a small bowel resection was the commonest surgical procedure performed. Presence of etiological risk factor for developing intestinal lymphoma was detected in 6 patients (40%). The overall morbidity rate was 40.0% (6 patients) and the mortality rate was 53,3% (8 patients). The estimated 12, 24, and 36-months overall survival rate was 56%, 33%, and 22% respectively.
DISCUSSION: Our study reports an elevated overall mortality accounting for 8 patients which were all but two of advanced stage; 6 patients died in the postoperative course. Univariate and multivariate analysis failed to show significant differences maybe because the total number of subjects was too small to reach statistical significance. However the Odds Ratio was significantly high for the presence of etiological risk factor (OR 7.50) and perforation as presenting symptom (OR 6.67).
CONCLUSION: An aggressive surgical attitude comprising an ample ileum resection is needed in almost all cases because an acute presentation is closely related with an advanced stage of the disease and with a high risk for anastomotic disruption, both conditions leading to a poor short and long-term survival.