L. H. Maguire1, T. M. Geiger2, R. Muldoon2, M. B. Hopkins2, M. M. Ford2, A. T. Hawkins2 1University Of Michigan,Colorectal Surgery,Ann Arbor, MI, USA 2Vanderbilt University Medical Center,Colorectal Surgery,Nashville, TN, USA
Introduction: Primary rectal lymphoma is an uncommon and heterogeneous malignancy. Due to its rarity, few data exist to guide treatment or counsel patients. Surgery can be considered a primary treatment or an element of multidisciplinary therapy, but there exists little evidence beyond the case report level on the short and long term outcomes of surgical treatment of rectal lymphoma. Here we present the largest series to date of patients undergoing non-palliative surgery for rectal lymphoma. We hypothesize that there will be no difference in overall survival between patients undergoing local or radical resection.
Methods: The National Cancer Data Base (NCDB) was queried for all cases of primary rectal lymphoma between years 2004 and 2014 who underwent resection. Exclusion criteria included patients with Stage IV disease and those operated on for palliation. Patients were categorized by resection approach-local (LR) or radical (RR). Approach, along with demographic, histologic, hospital level and treatment factors were analyzed for effect on survival with Cox Proportional Hazard analysis.
Results:After applying exclusion criteria, 233 patients were identified. Mean age was 63 (IQR 53-73) and 57% of the population was female. The most three most common histologic subtypes were Marginal (44%), Diffuse Large B-Cell (DLBCL) (20%) and Follicular Lymphoma (17%). 87% underwent local resection including endoscopic and transanal procedures. Age, sex, race, Charlson comorbidity score, or facility type were not significantly different between patients undergoing local versus radical resection, but local resection patients were significantly more likely to be Stage I (81% versus 55%, p =0.001). There was no significant difference in R0 resection (LR:38% vs RR: 58%; p=0.07), adjuvant chemotherapy (LR:18% vs RR: 29%; p=0.22), or adjuvant radiation (LR:21% vs RR: 16%; p=0.63) between the groups. 5-year overall survival was 79%, and there was no significant difference in approach (LR:81% versus RR: 56%, p =0.06) (Figure 1). However, DLBCL type was associated with poorer survival (Marginal: 87% , DLBCL: 55%, Follicular: 85%; p<0.001). Multivariable analysis did not identify an association between surgical approach and overall survival.
Conclusion:Surgical resection of rectal lymphoma is rare. Without evidence-based guidelines, treatment is individualized to patient and tumor characteristics. We present the largest series of surgical rectal lymphoma patients, but given the rarity of the disease our study is limited by retrospective approach and small patient numbers. Our data support consideration of local resection when possible, given the lack of convincing survival benefit of radical surgery or R0 resection.
