The Role of Surgery in the Treatment of Primary Gastric Lymphoma

Yoo, Chang Hak; Noh, Sung Hun; Kim, Yong Il; Suh, Jin Hak; Min, Jin Sik; Lee, Kyong Sik

Abstract

BACKGROUND AND AIMS: Prirnary gastric lymphoma is an uncommom tumor, constituting less than 5% of gastric malignancies. Optimal treatment of early-stage gastric lymphoma has been a matter of debate for several years. Our purpose in this study is to evaluate the exact role of surgery in the treatment of gastric lymphoma.
METHODS
Retrospective study of 63 patients, treated at the Dept. of Surgery, Yonsei Univ., College of Medicine from 1980 to 1994 was performed. Survival and multivariate analyses were done using the Kaplan-Meier method and Coxs proportional hazard model.
RESULTS
The mean age was 49.4 years, the ale to female ratio was 1.5:1 and the mean tumor size was 5.lcm in maximal diameter. The distribution of histologic grade according to the Working formulation was low-grade (n=24), intermediate-grade (n=32), high-grade (n=7) and high with low-grade (n=l). The distribution of stage according to the criteria of Musshoff was I (n=35), II-1 (n=l 1), II-2 (n=14), IV (n=3). Fifty two patients underwent gastric resection: subtotal (n=29), total (n=23) and the remaining 11 patients were diagnosed by laparotomy biopsy (n=4) and endoscopic biopsy (n=7) without gastric resection. Treatment modalities included surgery (S), chemotherapy (CT), and radiotherapy (RT) in the following proportions: only S (n=l9), S+CT (n=17), S+RT (n=4), S+CT+RT (n=12) and CT+RT (n=l 1). The overall 5-year survival rate was 72.5%. The 5-year survival rates according to stage were 87.3% in stage I, 76.2% in II-1, and 45.7% in II-2. No difference in survival rate was found according to treatrnent modality. Significant prognostic factors by univariate analysis were histologic grade, multifocality, lymph node metastasis, gastric resection and stage. Among them, independent prognostic factor by multivariate analysis was stage (p=0.0011).
CONCLUSIONS
We suggested that surgical role in the treatment of early gastric lymphoma (stage I, II) may still be primary therapeutic procedure and the extent of sugical resection should be a standard radical gastrectomy with D2 or D2+a lymph node dissection. But in the intermediate or high grade tumor, multifocal lesions, LN metastasis and advanced stage, chemotherapy or radiotherapy should be considered as adjuvant therapy.