Primary gastrointestinal lymphomas (PGL) account for the majority of gastrointestinal extranodal lymphomas in adults, with intestinal lymphomas ranking second [6, 7]. In contrast, the intestine is the most commonly afflicted site in children and adolescents, whereas the stomach accounts for only 10% of gastrointestinal lymphomas [8]. It is well known that stomach lymphoma is largely an adult illness, peaking in incidence between the sixth and seventh decades of life [7]. DLBCL is more common in adults, whereas Burkitt lymphoma is the most common histological type in children and adolescents. Additionally, a higher percentage of the pediatric group underwent surgical resection than that of the adult group.

In this study, we presented one of the largest datasets to explore the role of surgical resection and chemotherapy treatment in pediatric and adolescent PGINHL. Our research verified what had already been documented, namely that Burkitt lymphoma was the primary histological subtype of these tumors and that most of them were found in the small bowel. Although boys are more likely than girls to develop malignancies, our research found no difference in survival rates between the genders. Except for stomach NHL, which appears with distant disease in 42.5% of cases, most of these tumors develop at the loco-regional stage. However, no significant survival difference was found between localized and distant stages. Tumor location was found to be a reliable predictor of survival in the univariate analysis. However, primary sites had no significant relationship with survival in the multivariate model. We also found no significant difference in survival between those who had surgery and those who did not, which is in line with earlier published reports on pediatric and adolescent PGINHL [9].

Over the years, the role of surgery in the treatment of pediatric abdominal lymphoma has changed substantially. Historically, the majority of PGL treatment was surgical excision, followed by postoperative chemotherapy. Series from the early 1990s indicated the survival advantage of near-complete excision of the original tumor in patients with abdominal lymphoma [10,11,12]. Due to improved treatment protocols, debulking surgery is no longer advocated, and surgical resection is now only recommended for localized disease, or individuals presenting with intestinal obstruction [13, 14]. However, it was discovered after the 1990s that rigorous chemotherapy alone was successful for high-grade stomach lymphoma [15]. The outcome for advanced stage patients without major surgical resection has improved with current treatment methods [16]. Chemotherapy was found to be the most effective intervention in our study for increasing survival. 91.5% of individuals with PGINHL underwent chemotherapy. The absence of chemotherapy has become the most significant factor influencing survival. The chemotherapy group had a 5-year and 10-year OS of 94% and 93.4%, respectively, which was considerably greater than the no-chemotherapy group (78.4% for both the 5-year and 10-year OS). Furthermore, the Cox proportional hazard regression demonstrated that only chemotherapy considerably reduced the chance of death.

The current study has a number of potential limitations that should be considered. Firstly, a lot of specific clinical data was not documented, including diagnostic techniques, chemotherapy regimens, and immunotherapy. Secondly, although data on the receipt of surgery was available, information about about the types of surgery (biopsy or tumor resection) was not available. Finally, the patients in the SEER database are mostly white or black, which may limit the conclusion's application to children of other races. A future study is therefore necessary to confirm the findings.

In conclusion, we used a population-based dataset to evaluate the clinical features and prognosis of pediatric and adolescent PGINHL. Chemotherapy was discovered to be the most important predictor of survival. Our findings showed no advantage of surgical resection, reiterating the importance of chemotherapy as the main treatment methods.