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Role of Surgery in Abdominal Non-Hodgkin’s Lymphoma

Non-Hodgkin’s lymphoma (NHL) is a heterogeneous group of malignancies of the lymphatic system. While the disease primarily involves lymph nodes, it can also arise in extranodal sites, with the gastrointestinal (GI) tract being the most commonly affected site. Abdominal non-Hodgkin’s lymphoma can involve any part of the GI tract, from the stomach and small intestine to the colon and rectum. The role of surgery in the management of abdominal NHL has evolved significantly over the years and remains a topic of ongoing debate. This article reviews the current understanding and application of surgery in the treatment of abdominal non-Hodgkin’s lymphoma.

Therapeutic Paradigms and the Role of Surgery

Traditionally, the primary modality for treating non-Hodgkin's lymphoma has been chemotherapy, with or without radiotherapy, based on the type and stage of the disease. However, the role of surgery has shifted from a therapeutic to a largely diagnostic and supportive role.

Today, surgical intervention in abdominal NHL is generally reserved for specific situations, including:

  1. Diagnosis and Staging: A biopsy is typically required to confirm the diagnosis of NHL. This may be obtained through endoscopy, image-guided biopsy, or occasionally surgical biopsy if less invasive methods are unsuccessful. Staging laparotomy, once a common practice in lymphoma management, has largely been replaced by less invasive imaging techniques.
  2. Management of Complications: Surgical intervention may be necessary for emergent situations such as bowel perforation, obstruction, hemorrhage, or acute abdomen, which can occur in aggressive cases of abdominal NHL.
  3. Debulking Surgery: The role of debulking surgery (removal of a significant portion of the tumor) is controversial in NHL, as lymphomas are generally considered systemic diseases. However, it may be considered in specific cases, particularly when the disease is localized and causing severe symptoms, or to improve the efficacy of adjuvant therapies.

Risks and Considerations of Surgery

While surgery can offer benefits in certain situations, it's not without potential risks. These can include surgical complications such as infection, bleeding, and damage to nearby organs, as well as longer-term impacts such as bowel dysfunction. Additionally, the recovery time required after surgery can delay the initiation of systemic therapies, which can be detrimental in a disease like NHL that often progresses rapidly.

Therefore, the decision to proceed with surgical intervention should be made carefully, with consideration of the individual patient's disease characteristics, overall health status, and personal wishes. Multidisciplinary discussions involving medical oncologists, radiation oncologists, and surgeons are key to devising an optimal, personalized treatment plan for each patient with abdominal NHL.

The role of surgery in the treatment of abdominal non-Hodgkin’s lymphoma has evolved significantly, with an increased understanding of the disease's systemic nature and advances in systemic therapies. While surgery is no longer a primary treatment modality, it still has an important role in diagnosis, management of complications, and occasionally, debulking. As our knowledge and treatment strategies continue to evolve, the role of surgery will continue to be refined, with the ultimate goal of improving patient outcomes.