Clinicopathological characteristics and surgical value of primary gastrointestinal lymphoma

Abstract

BACKGROUND

Primary gastrointestinal lymphoma (PGIL) is a relatively uncommon clinical entity, exhibiting distinctive features including occult primary sites, nonspecific clinical presentations, and considerable diagnostic and therapeutic difficulties. Consequently, comprehensive clinical investigations into its clinicopathological characteristics and surgical intervention value are warranted to enhance diagnostic and therapeutic proficiency.

AIM

To investigate the clinicopathological characteristics and surgical significance of PGIL from a surgical perspective, providing a theoretical basis for optimizing diagnostic and therapeutic strategies.

METHODS

This study included 50 cases of PGIL treated by the General Surgery Department of the Chinese PLA Air Force Medical Center from June 2001 to March 2025. Data were extracted from the Electronic Medical Record system for retrospective analysis. A retrospective analysis was conducted on their epidemiological, clinical manifestations, imaging, pathological features, and treatment outcomes. Descriptive statistics were applied for data summarization, with continuous variables presented as frequencies and percentages. Correlations between variables were assessed using the Spearman rank correlation coefficient.

RESULTS

All cases had the gastrointestinal tract as the primary site. Abdominal pain was the most common initial symptom (52.0%), with 80.0% of patients experiencing pain during the course of the disease, and 38.0% experiencing hematochezia/melena or anemia. Computed tomography diagnosis exhibited a high overall sensitivity (94.3%); the endoscopic detection rate was 91.5%. Diffuse large B-cell lymphoma was the most common subtype (52.0%). The improvement rate was higher in the surgery combined with chemotherapy group than in the chemotherapy only group. The incidence of postoperative complications was 26.5%, all occurring in patients with tumors > 5 cm.

CONCLUSION

Diffuse large B-cell lymphoma is the primary PGIL subtype. Imaging and endoscopic biopsy are diagnostic essentials. Surgery aids in resection, complication management, and pathologic diagnosis. Multidisciplinary, individualized strategies are recommended, necessitating further prospective molecular studies.

Keywords: Gastrointestinal lymphoma; Multimodal diagnostics; Clinical characteristics; Surgical operation; Multimodal diagnostics

Core Tip: Primary gastrointestinal lymphoma predominantly manifests as diffuse large B-cell lymphoma, with abdominal pain as the leading symptom. Comprehensive diagnosis relies on imaging (computed tomography sensitivity: 94.3%) and endoscopic biopsy (detection rate: 91.5%). Surgery is pivotal for definitive diagnosis (via complete specimen acquisition), emergency management (e.g., obstruction/perforation), and primary lesion resection, particularly for tumors > 5 cm (26.5% complication rate). While combined surgery and chemotherapy showed higher improvement rates than chemotherapy alone, statistical significance was not reached. Integration of surgical strategies into multimodal therapy may optimize outcomes, emphasizing individualized approaches based on tumor size, stage, and complications.