Background: Diffuse large B-cell lymphoma (DLBCL) is commonest pathological type of gastrointestinal lymphoma and its management was changed from surgery to combined chemoimmunotherapy in the last decade however this strategy is questionable especially if rituximab is not available.
Methods: 79 files were reviewed retrospectively. We divided the patients into 2 groups; (group-1) Included 37 patients who underwent surgery followed by chemotherapy and (group -2) included 42 patients who received chemotherapy .The indication of surgery was mainly due to obstruction/perforation.
We compared the efficacy of using surgery between the 2 groups and between primary anatomical site subgroups regarding their PFS and OS.
Results: We found using surgery before chemotherapy was superior to chemotherapy alone in term DFS p= 0.012 and OS p=0.037. But in the anatomical subgroups analysis, it did not show any significant difference in primary gastric lymphoma (PGL) regarding DFS and OS p=0.706, p=0.858, in contrary, we found significant improvement in PFS and OS p=0.032, p=0.025 in primary intestinal lymphoma (PIL) favoring use surgical approach.
Conclusion Surgery is still an important strategy in case of DLBCL in PIL intestinal lymphoma however in case of PGL using chemotherapy even without rituximab achieve similar results. However our small sample size should be considered.