The role of surgery in American Burkitt's lymphoma in children.

The records of 28 children with the pathological diagnosis of American Burkitt's lymphoma were reviewed. Twenty-three of these children (82%) presented with primary abdominal tumors and 5 with disease located in the head and neck. Twelve required an emergency operation for either intestinal obstruction (3), intussusception (5), or appendicitis (4); the others underwent an elective exploration for tissue diagnosis. Ten patients had disease localized to one particular site. Seven of these 10 children underwent complete resection of the tumor including a right colectomy (4), small bowel segmental resection (1), tonsillectomy (1), and appendectomy (1). Eight children had a subtotal resection of the tumor (less than 90% of tumor burden) and the rest underwent incisional biopsies. Following the diagnosis, all patients received chemotherapy; 8 (29%) also were treated concurrently with radiation therapy. Nineteen patients (70%) remain long-term survivors with a mean survival time of 3.6 years. Eight patients died of either recurrent disease (6) or sepsis secondary to their chemotherapy, with a mean survival time of 6 months. Sixteen patients (57%) developed complications during their hospitalization that required surgical consultation or intervention (acute renal failure [9], pleural effusion [2], intestinal obstruction [5], gastric outlet obstruction [1], and wound infection [1]). No subsequent treatment of these complications resulted in mortality or morbidity. The significant positive determinant for survival was the initial absence of either bone marrow or central nervous system involvement (P less than .05). In those children who had complete resection of their tumor, survival time was greater than 3.7 years.(ABSTRACT TRUNCATED AT 250 WORDS)