The Evolving Role of Surgery for Gastric Lymphoma: From Curative Resection to Surgical Management of Complications

Abstract

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Clinical Significance of “Double-hit” and “Double-protein” expression in Primary Gastric B-cell Lymphomas

“…In this study, surgery was a mainly treatment to patients at stage II or higher. The incidence of chemotherapy/radiotherapy-related gastric perforation or hemorrhage in this study was lower than those in other reports 8 , 9 , 30 . Although there are recent debates on the necessity of the invasive modality, compared with conservative treatment to gastric lymphomas, we suggest that surgery is still the best way to prevent chemotherapy/ radiotherapy related complication and tumor recurrence 30 .…”

“…In order to determine the optimal management strategy for gastric lymphomas, appropriate clinical staging is also full of challenge. Actually, it is controversial as to which classification is the best system for staging of gastric lymphomas 1 - 3 , 6 - 9 . Therefore, a new composite prognostic index including clinical issues, pathological morphology, and molecular biology biomarkers is imperative for clinical stratified management of gastric B-cell lymphoma.…”

“…But significant difference of CD10 and MUM1 expression were not obtained among different histological types of gastric B-cell lymphomas. The gastrectomy in the management of gastric lymphoma has been nowadays also reserved for those patients with disease- or treatment-related complications due to potentially increasing the risk of morbidity and mortality 8 , 9 , 30 . In this study, surgery was a mainly treatment to patients at stage II or higher.…”

“…Historically, surgical intervention played a critical role in the multimodal management of gastric lymphoma 6 , 7 . However, with the emergence of data demonstrating comparable outcomes with lower morbidity and better quality of life with chemotherapy and radiation, there has been a shift toward non-operative management for these patients 8 , 9 . In fact, there is still no consensus on the optimal treatment for gastric B-cell lymphoma, especially for H. pylori negative MALT lymphomas, and more aggressive treatment is also commonly used for gastric DLBCL in clinical setting.…”

Addition of Rituximab to Chemotherapy Reduced the Rate of Surgery for Gastric-DLBCL Without Increasing Early Mortality

“…l'Adulte study from 2005, it was shown that complete response (47.5% vs. 28%), event-free survival (47% vs. 29%), progression-free survival (54% vs. 30%), disease-free survival (66% vs. 45%), and OS (58% vs. 45%) were statistically significantly all in favor of rituximab-CHOP over CHOP alone (9). Another study by Habermann et al published in 2006 showed that rituximab administered as induction or maintenance with CHOP chemotherapy significantly prolonged failure-free survival (53% vs. 46%) in older patients with DLBCL when compared to those who received CHOP alone (10).…”