Surgery first significantly enhances survival and safety in primary intestinal lymphoma compared to chemotherapy first.

• 3-year and 5-year overall survival rates were higher in the surgery first group (p < 0.05).
• Patients under 60, with stage I-II disease and low international prognostic index (IPI) scores, saw even greater survival benefits (p < 0.05).

You should prioritize surgery first for suitable patients to optimize outcomes and minimize complications.

• Perioperative complications were notably lower in the surgery first group (2.86% vs. 36.17%, p < 0.001).