When is lymph node excision and dissection indicated in the treatment of pediatric non-Hodgkin lymphoma (NHL)?

Updated: Jun 14, 2018
  • Author: J Martin Johnston, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Answer

Even for patients with bulky non-Hodgkin lymphoma, debulking surgery is not crucial to effective therapy. For example, chemotherapy is effective in relieving partial airway or bowel obstruction. In rare instances, resection may be required for this purpose.

The chief role for surgery is obtaining tissue for diagnosis. Excision of an easily accessible lymph node (when present) is preferable to a thoracotomy or laparotomy, unless symptoms dictate otherwise. Even moderately aggressive surgery generally is not necessary or helpful.

One exception, and a potential therapeutic dilemma, involves abdominal B-cell non-Hodgkin lymphoma. The patient can be assigned to clinical group A (see Table 3) if the following conditions are met:

  • An intestinal primary lesion can be resected along with all involved adjacent lymph nodes

  • The marginal lymph nodes are free of disease

  • The patient has no evidence of further dissemination (eg, to the CNS or marrow)

In this situation, the prescribed chemotherapy regimen is far less toxic than it would be otherwise. Therefore, a surgeon treating a reasonably small abdominal non-Hodgkin lymphoma is advised to perform lymph node dissection and to try to excise all visible areas of tumor.

However, this surgery is performed only if it can be accomplished without causing clinically significant morbidity. Heroic attempts at resection are best avoided because unresected disease can still be cured in most patients. Furthermore, prolonged postoperative recovery may delay the start of chemotherapy and potentially compromise its effectiveness.

Second-look surgery may be helpful for assessing the viability of residual masses, although second-look procedures require highly individualized approaches. As an alternative, uptake of67 Ga or radiolabeled FDG suggests viability of residual masses in patients whose tumors are gallium or FDG avid.


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