Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
J Surg Res. 2019 Dec;244:189-195. doi: 10.1016/j.jss.2019.06.034. Epub 2019 Jul 9.
Primary rectal lymphoma is an uncommon and heterogeneous malignancy. Because of its rarity, few data exist to guide treatment or counsel patients. We present the largest series to date of patients undergoing nonpalliative surgery for rectal lymphoma. We hypothesize that there will be no difference in overall survival between patients undergoing local resection (LR) or radical resection (RR).
The National Cancer Data Base was queried for all cases of resected primary rectal lymphoma between years 2004 and 2014. Exclusion criteria included patients with stage IV disease and those operated on for palliation. Patients were categorized by resection approach-LR or RR. Approach along with demographic, histologic, and hospital-level factors were analyzed with a Cox proportional hazard analysis.
A total of 233 patients were identified. Mean age was 63 y (interquartile range 53-73), and 57% of the population was female. The most common histologic subtypes were marginal (44%), diffuse large B-cell (20%), and follicular lymphoma (17%). Eighty-seven percent underwent LR. There was no significant difference in R0 resection (LR: 38% versus RR: 58%; P = 0.07), adjuvant chemotherapy (LR: 18% versus RR: 29%; P = 0.22), or adjuvant radiation (LR: 21% versus RR: 16%; P = 0.63) between the groups. Five-year overall survival was 79%, and there was no significant difference in approach (LR: 81% versus RR: 56%, P = 0.06). Multivariable analysis did not identify an association between approach and overall survival.
Surgical resection of rectal lymphoma is rare. Our data support consideration of LR when possible, given the lack of convincing survival benefit of radical surgery or R0 resection.
原发性直肠淋巴瘤是一种罕见且异质性的恶性肿瘤。由于其罕见性，几乎没有数据可以指导治疗或为患者提供咨询。我们报告了迄今为止最大的一组接受非姑息性手术治疗直肠淋巴瘤的患者系列。我们假设接受局部切除（LR）或根治性切除（RR）的患者的总生存率没有差异。
2004 年至 2014 年间，国家癌症数据库中检索到所有接受直肠淋巴瘤切除术的病例。排除标准包括 IV 期疾病患者和姑息性手术患者。根据手术方式（LR 或 RR）对患者进行分类。采用 Cox 比例风险分析方法分析手术方式以及人口统计学、组织学和医院水平因素。
共确定了 233 名患者。平均年龄为 63 岁（四分位间距 53-73 岁），57%的患者为女性。最常见的组织学亚型为边缘型（44%）、弥漫性大 B 细胞型（20%）和滤泡性淋巴瘤（17%）。87%的患者接受了 LR。LR 组和 RR 组的 R0 切除率（LR：38%对 RR：58%；P=0.07）、辅助化疗（LR：18%对 RR：29%；P=0.22）和辅助放疗（LR：21%对 RR：16%；P=0.63）无显著差异。5 年总生存率为 79%，手术方式无显著差异（LR：81%对 RR：56%，P=0.06）。多变量分析未发现手术方式与总生存率之间存在关联。
直肠淋巴瘤的手术切除较为少见。鉴于根治性手术或 R0 切除对生存率没有明显获益，我们的数据支持在可能的情况下考虑 LR。
