Paediatric lymphoma: The surgeon's role

Even though the historic 'staging laparotomy' for the biopsy of nodes, the liver and the spleen in patients with lymphoma is no longer protocol due to the accuracy and availability of cross-sectional and nuclear imaging and that lymphoma is predominantly treated by chemotherapy, the surgeon is still an active member in the multidisciplinary team managing these patients. The primary role of the surgeon is to acquire a sufficiently sized and representative biopsy of the lesion to allow for appropriate histological analysis including genetic and molecular phenotyping. Further roles include the management of surgical presentations where lymphoma is the underlying pathology, management of surgical complications of advanced disease or due to chemotherapy as well as the insertion of central venous access devices. The surgeon needs to fully understand the nature of the disease to avoid life-threatening complications of unplanned or inappropriate surgery. This chapter provides the surgeon with some basic information on the various types, the incidence and demographics of childhood lymphoma and how patients with lymphoma may present to the surgeon. Aspects related to tumour biopsy techniques and management of intrathoracic and intra-abdominal disease are discussed highlighting specific considerations and potential pitfalls in these areas. Surgery in these patients, whether a biopsy in a stable patient or a procedure for an emergent presentation or complication of management, should be well planned with the emphasis on the least invasive approach and avoidance of extensive or destructive procedures.