Surgeon's role in the management of lymphomas

Abstract

A retrospective analysis of the lymphomas treated at the Department of Surgery, T.U. Teaching Hospital, Kathmandu between 1995 to 1999 was carried out in an attempt to clarify the role of surgeons in the management of such cases. Sixty patients with the diagnosis of lymphoma mainly NHL (52 cases), were admitted during the past 5 years. The average age was 41�17 years ranging from 7 to 70 years. The female to male ratio was 1:1.5. The majority of NHL patients (80%) presented with superficial lymphadenopathy, most commonly in the cervical lymph nodes, where almost 50% of cases were diagnosed by FNAC. The rest - 20% (9 cases) presented with abdominal lump where laparotomy was performed in 7 cases and USG guided FNAC was done in 2 cases to confirm the diagnosis of lymphoma. Six cases (11.5%) of NHL were of extra-nodal origin (4 stomach and 2 colon). All 6 cases were subjected to radical surgery for carcinoma. According to the Ann Arbor staging system, most of the lymphoma cases were in stage III or IV and 25% of the cases presented with B symptoms. Serum LDH correlated with therapeutic response in 80% of nodal lymphomas (8 out of 10 cases). Almost all the patients received chemotherapy with most commonly used regimens - CHOP, BACOP or MOPP. However, 20% of the patients failed to complete the course of chemotherapy. There was 3 mortality (5%) during therapeutic course because of the progressive recurrent disease. Although the follow-up records were available for half of the cases, major morbidity included recurrence of the disease in two cases, CNS involvement in two cases and second malignancy in one case following the treatment of lymphomas. Therefore, in our set up, a surgeon has a sole responsibility for putting tissue diagnosis, relieving the complication of the disease or treatment, chemotherapy of the lymphomas, especially NHL.