Surgery in castlemans disease: A systematic review of 404 published cases

ObjectiveS: We undertook a systematic review of 404 published cases of Castlemans disease to identify the role of the surgeon beyond assistance in tissue-based diagnosis. Background: Castlemans disease is a rare primary disease of the lymph node caused by infection with herpesviridae. Little is known about the role of surgery in this condition. Data Sources: Medline, Embase, Cochrane Database of Systematic Reviews, ISI Thompson Web of Knowledge, and hand search of articles bibliography. Study Selection: Of the 1791 citations identified through the initial electronic search and screened for possible inclusion, 488 articles were retained after title and abstract reviews. Of these, 239 were accepted for this review. Data Extraction: A complete dataset containing age, gender, centricity (unicentric vs multicentric), histopathologic type (hyaline vascular [HV] vs plasma cell [PC]), anatomical location of the only focus in unicentric Castlemans disease (UCD) or the dominant focus in multicentric Castlemans disease (MCD), nature of the surgical approach (resective vs diagnostic), and outcome (disease-free survival [DFS] vs death due to disease) was extracted. Results: A resective or debulking surgical approach was described in 77.0% of all patients, but was far more common in unicentric (262/278; 94.2%) than multicentric (49/126; 38.9%) disease (χ 146.8; P < 0.0001). Unicentric disease had a significantly higher overall survival (95.3% vs 61.1%; χ 55.7; P < 0.0001), 3 year DFS (89.7% vs 55.6%; χ 27.8; P < 0.0001), and 5 year DFS (81.2% vs 34.4%; χ 28.6; P < 0.0001) than multicentric disease. Failure to treat unicentric disease by resective surgery resulted in a significant mortality (17.6% vs 3.8% χ; P < 0.05). In multicentric disease, outcomes are comparable between debulking surgery alone, immunochemotherapy alone, or a combination of both (28.0% vs 28.9% vs 50.0%; P = nonsignificant). Conclusions: Surgery is the gold standard for treatment of unicentric Castelmans disease. The role of debulking surgery in human immunodeficiency virus (-) MCD needs to be evaluated in prospective studies.