Ninety-two patients with American Burkitt's lymphoma were studied retrospectively to elucidate the role of surgery in the complications of treatment of Burkitt's lymphoma. All of the patients reviewed had been treated with at least one chemotherapeutic agent. Seventy-five percent of the patients had predominantly abdominal disease that required a laparotomy for diagnosis and treatment when possible. The postoperative complications, such as infections, were not more frequent when compared with other elective surgical procedures. Ten percent of all the patients had episodes of significant gastrointestinal bleeding secondary to disease or to the chemotherapy. One patient was treated surgically, and two patients had fatal hemorrhages. Further abdominal complications that required surgery included intussusception, cholelithiasis, small bowel obstruction, and bowel perforation. The incidence of renal failure because of electrolyte imbalance from tumor lysis syndrome was 30%. One third of these patients required access for dialysis. Ten percent of patients developed hemorrhagic cystitis, but none required surgery. Surgery was necessary in five patients with life-threatening pericardial effusion. Other surgical treatments are also reviewed. It is concluded that Burkitt's lymphoma has a significant cure rate with the appropriate medical and surgical therapies, and that the surgical approach to the disease and its complications should be optimistic and approriately aggressive.