The role of surgery in the treatment of pediatric B-cell non-Hodgkin's lymphoma.

Background: Within the last 20 years, the role of surgery in the management of pediatric B-cell non-Hodgkin's lymphoma (B-NHL) has changed substantially. Along with the assignment of risk-adjusted therapy and specific treatment protocols, surgical procedures have been restricted to defined situations including abdominal emergencies, diagnostic biopsy, total tumor extirpation and second-look operations.

Methods: The authors retrospectively analyzed the effect of initial surgery and second-look operation on event-free survival (EFS) in 79 patients with B-NHL (abdominal primary, n = 57; head or neck tumor, n = 22). Furthermore, the prognostic significance of the stage of disease for the patients analyzed was evaluated.

Results: Therapy results showed that the extent of resection did not have a significant influence on EFS and that stage of disease was of prognostic relevance only for patients with head and neck tumors. The number of patients who had a second-look operation (n = 12) was too small for statistical interpretation.

Conclusions: Because tumor resectability is determined by the stage of disease, which is the superimposed predictor of prognosis, the influence of the extent of resection on EFS cannot be interpreted independently. Nevertheless, the following conclusions can be drawn: in patients with proven localized disease, total resections should be attempted, if not mutilating, to avoid intensified chemotherapy. However, if only partial resections seem feasible, surgical interventions should be restricted to the least necessary procedures for treating life-threatening local tumor effects and establishing a definite diagnosis.