Primary Gastrointestinal Lymphoma: A Retrospective Cohort Study on Clinical Presentation, Treatment Outcomes, and Survival Trends With a Focus on Emergency Versus Elective Management

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Abstract
Purpose: Primary gastrointestinal lymphoma (PGIL) is a rare cancer, with diffuse large B‐cell lymphoma (DLBCL) as the most common subtype. PGIL can be acute, requiring emergency surgery, or non‐acute, allowing elective management. This article evaluates the clinical presentation, treatments, and survival outcomes of PGIL by comparing emergency and elective cases. Methods: A retrospective cohort study from January 2013 to December 2019 included patients with histologically confirmed PGIL, excluding secondary GI involvement. Survival distributions were performed using SPSS v.20 and Kaplan–Meier analysis. Results: Among 33 patients, 54.5% were male, with a mean age of 69. The most common site of lymphoma was the small bowel (54.5%), with DLBCL being the predominant subtype (66.7%). Emergency cases comprised 57.6% of the cohort. Poorer survival was noted in emergency cases, with significant differences in survival by age ( p = 0.036) and lymphoma site ( p = 0.038). Surgical excision was the main diagnostic method in emergency cases (54.5%), while endoscopic biopsy was more common in elective cases (39.4%) ( p < 0.001). Chemotherapy was given to 69.7%, with R‐CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) (65.2%) being the most used regimen. Median survival was 17 months (interquartile range, IQR: 10–44.5). Survival differences were significant by age ( p = 0.036) and lymphoma site ( p = 0.038). Conclusion: Emergency surgery is often needed for PGIL, especially with small bowel lymphomas, which have poorer outcomes. Early diagnosis and elective care may improve prognosis. Further research should explore prognostic markers and standardize treatment.

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