Management and long-term results of surgery for localized gastric lymphomas

https://doi.org/10.1016/S0002-9610(00)00295-6Get rights and content

Abstract

Background: High- and low-grade gastric lymphomas (GL) differ in their behavior and chemosensitivity. Surgery has to be reevaluated according to the histologic grade of malignancy. We aimed to assess the place of surgery in the management of GL and its results after long-term follow-up.

Methods: Among 54 patients with primary GL prospectively enrolled from 1984 to 1990, 45 with localized disease were studied. Primary resection was done whenever safe. All patients received chemotherapy adapted to the grade of malignancy and/or to the completeness of the resection.

Results: Among 18 low- and 27 high-grade GL, 35 patients had primary resections; of those, 23 were complete. The complete response rate for all patients with low- and high-grade GL was 67% and 89%, respectively. After a median follow-up of 8 years, the disease-free survival rates for low-grade GL and high-grade GL were 94% and 89%, respectively. It was better after complete resection.

Conclusion: Complete resection is a major determinant of prolonged complete remission.

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

References (40)

  • V.L Rackner et al.

    Role of surgery in multimodality therapy for gastrointestinal lymphoma

    Am J Surg

    (1991)
  • G Salles et al.

    Aggressive primary gastrointestinal lymphomasreview of 91 patients treated with the LNH-84 regimen. A study of the Groupe d’Etude des Lymphomes Digestifs

    Am J Med

    (1991)
  • B.G Taal et al.

    Primary non-Hodgkin’s lymphoma of the stomachchanging aspects and therapeutic choices

    Eur J Cancer Clin Oncol

    (1989)
  • C Tondini et al.

    Initial chemotherapy for primary resectable large-cell lymphoma of the stomach

    Ann Oncol

    (1997)
  • W Fischbach et al.

    Malignant lymphomas of the upper gastrointestinal tractresults of a prospective study in 103 patients

    Cancer

    (1992)
  • R Liang et al.

    Prognostic factors for primary gastrointestinal lymphoma

    Hematol Oncol

    (1995)
  • K Musshoff

    Klinische Stadieneinteilung der Nicht-Hodgkin Lymphome

    Strahlentherapie

    (1977)
  • The Non-Hodgkin’s Lymphoma Pathologic Classification Project. National Cancer Institute-sponsored study classification...
  • P.G Isaacson

    Recent developments in our understanding of gastric lymphomas

    Am J Surg Pathol

    (1996)
  • M.B Azab et al.

    Prognostic factors in primary gastrointestinal non-Hodgkin’s lymphoma. A multivariate analysis, report of 106 cases, and review of the literature

    Cancer

    (1989)
  • Cited by (32)

    • A systematic review of primary gastric diffuse large B-cell lymphoma: Clinical diagnosis, staging, treatment and prognostic factors

      2021, Leukemia Research
      Citation 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 Leukemia
      Citation 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

    • MALT gastric lymphomas

      2004, Revue de Medecine Interne
    View all citing articles on Scopus

    This work was supported in part by Laboratoires Houdé, Neuilly, France.

    View full text