title: Surgical treatment of primitive gastro-intestinal lymphomas: a systematic review.
abstract: Primitive Gastrointestinal Lymphomas (PGIL) are uncommon tumours, although time-trend analyses have demonstrated an increase. The role of surgery in the management of lymphoproliferative diseases has changed over the past 40 years. Nowadays their management is centred on systemic treatments as chemo-/radiotherapy. Surgery is restricted to very selected indications, always discussed in a multidisciplinary setting. The aim of this systematic review is to evaluate the actual role of surgery in the treatment of PGIL. A systematic review of literature was conducted according to the recommendations of The Cochrane Collaboration. Main outcomes analysed were overall survival (OS) and disease free survival (DFS). There are currently 1 RCT and 4 non-randomised prospective controlled studies comparing surgical versus medical treatment for PGIL. Seven hundred and one patients were analysed, divided into two groups: 318 who underwent to surgery alone or associated with chemotherapy and/or radiotherapy (surgical group) versus 383 who were treated with chemotherapy and/or radiotherapy (medical group). Despite the OS at 10 years between surgical and medical groups did not show relevant differences, the DFS was significantly better in the medical group (P=0.00001). Accordingly a trend was noticed in the recurrence rate, which was lower in the medical group (6.06 vs. 8.57%); and an higher mortality was revealed in the surgical group (4.51% vs. 1.50%).The chemotherapy confirms its primary role in the management of PGIL as part of systemic treatment in the medical group. Surgery remains the treatment of choice in case of PGIL acutely complicated, although there is no evidence in literature regarding the utility of preventive surgery.
authors: Department of Surgery, University of Perugia, Italy. cirocchiroberto@yahoo.it
authors: Roberto
authors: R
authors: Cirocchi
authors: Eriberto
authors: E
authors: Farinella
authors: Stefano
authors: S
authors: Trastulli
authors: Davide
authors: D
authors: Cavaliere
authors: Piero
authors: P
authors: Covarelli
authors: Chiara
authors: C
authors: Listorti
authors: Jacopo
authors: J
authors: Desiderio
authors: Francesco
authors: F
authors: Barberini
authors: Nicola
authors: N
authors: Avenia
authors: Antonio
authors: A
authors: Rulli
authors: Giorgio Maria
authors: GM
authors: Verdecchia
authors: Giuseppe
authors: G
authors: Noya
authors: Carlo
authors: C
authors: Boselli
mesh_terms: D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008223:Lymphoma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis