Management and long-term results of surgery for localized gastric lymphomas☆
Section snippets
Patients
From January 1984 through January 1990, 54 GL cases were prospectively collected and underwent an exhaustive work-up. Of those, 45 patients had localized GL and form the basis of this study. Forty-two patients were submitted to 43 surgical procedures, either primary (n = 40) or postponed after chemotherapy (n = 3), and 3 were never operated on. The tumors were either stage IE (confined to the digestive wall) or stage IIE (with adjacent, II1E, or regional, II2E, lymphatic spread) of the Ann
Methods
Primary surgical resection was recommended whenever possible except when requiring a procedure considered too large for low-grade indolent GL or when its potential risk could delay the chemotherapy for high-grade GL. The resection was considered complete in the absence of residual disease either macroscopically or microscopically on the section margins and/or in the absence of residual tumoral lymph nodes. All patients underwent chemotherapy, either initially or 3 weeks after surgery depending
Clinical presentation
Forty-five patients with stage IE (n = 30) and IIE (n = 15) GL were studied: 27 men and 18 women whose median age was 54.2 years (range, 18.7–77.3 years). Presenting symptoms are given in Table I. Two patients (4.5%) presenting with active gastric bleeding had an urgent gastrectomy for hemostasis. The mean delay between the first symptom and the diagnosis was 9.9 months (range 0 to 64.8).
Diagnosis: grade of malignancy
The pretherapeutic diagnosis of GL was obtained by means of endoscopic biopsies in 38 patients (84%).
Comments
After exhaustive clinical staging and precise histologic typing, 45 patients with localized GL had initial tumor reduction when possible or reasonable and chemotherapy adapted to the grade of malignancy and/or to the completeness of the resection. This prospective series of localized GL is one of the largest published until now. With an overall 5-year survival rate of 91%, the present strategy allowed a fair outcome especially when tumor resection was complete.
Advantages claimed for first-line
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Cited by (32)
A systematic review of primary gastric diffuse large B-cell lymphoma: Clinical diagnosis, staging, treatment and prognostic factors
2021, Leukemia ResearchCitation Excerpt :The multimodal treatment of surgery combined with chemotherapy and occasional radiotherapy has been widely accepted by many treatment centers. Many studies have reported that combination therapy can significantly improve the 5-year survival rate of PG-DLBCL patients [68–70]. Compared with chemotherapy alone, radical surgery combined with chemotherapy can significantly improve the prognosis of PG-DLBCL.
Italian society of hematology, italian society of experimental hematology, and italian group for bone marrow transplantation guidelines for the management of indolent, nonfollicular b-cell lymphoma (marginal zone, lymphoplasmacytic, and small lymphocytic lymphoma)
2015, Clinical Lymphoma, Myeloma and LeukemiaCitation Excerpt :The EP agreed that the critical endpoint for this issue should be complete lymphoma remission and patient quality of life. Gastric surgery has long been the standard therapy for localized gastric MALT lymphoma, with excellent results in terms of long-term survival.49-52 However, the benefit of surgery must be evaluated against the equivalent results offered by stomach-conservative approaches, which provide a substantially better quality of life.52-54
Clinical outcome of primary gastric lymphoma treated with chemotherapy alone or surgery followed by chemotherapy
2006, Journal of the Formosan Medical AssociationPrimary non Hodgkin lymphomas of the digestive tract
2005, EMC - HematologieMALT gastric lymphomas
2004, Revue de Medecine Interne
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This work was supported in part by Laboratoires Houdé, Neuilly, France.