The role of surgery in the multimodal treatment of primary gastric non-Hodgkin's lymphomas a report of 76 cases and review of the literature

Abstract

Seventy-six patients with primary gastric non-Hodgkin's lymphomas (PGL) were diagnosed, and 75 were treated between 1975 and 1985. According to the Working Formulation 22 patients had low-grade malignant histologic subtypes, 27 intermediate-grade, and 27 high-grade. Twenty-four cases were diagnosed by endoscopic biopsies, 52 through laparotomy biopsies. Forty-five underwent subtotal or total gastric resection; seven were considered unresectable at laparotomy; 23 did not undergo surgery because of the high operative risk, mainly due to advanced age and coexisting diseases; and one died of myocardial infarction a few days after admission, before starting therapy. All patients who did not undergo laparotomy were staged with bipedal lymphangiography or abdominal ultrasonography and/or computed tomography. Stage, evaluated according to the criteria of Musshoff, was I or II1 in 16 cases, II2 in five, and IV in the remaining 55. Treatment modalities included surgery (S), chemotherapy (CT), radiotherapy (RT), and combinations thereof in the following proportions: only S in ten cases, S + CT in 32 cases, S + RT in one case, S + CT + RT in two cases, CT only in 25 cases, CT + RT in five cases. No substantial differences in response to therapy and in survival were found in relation to the different treatments. Ten-year survival was 43% in Stage I or II and 20% in Stage IV. Of the 45 resected patients, five postoperative deaths were recorded (11%). No bleeding or perforations were observed in the 30 unresected patients, and survival of such cases compared with that of the resected ones. These findings, together with data from the literature, suggest that some of the advantages claimed for surgery in PGL (debulking and abatement of the risk of perforation or hemorrhage during CT or RT) have been overestimated in relation to the intrinsic surgical risk and to the possibility of anticancer therapy. Gastric resection may still be unavoidable as a diagnostic procedure in a minority of cases and may represent the primary therapeutic procedure in clinically assessed early-stage and low-risk patients, but it cannot be considered mandatory whenever possible merely for debulking purposes or to obviate possible perforation or hemorrhage. The CT and/or RT can be effective in unresected and even bulky cases, providing minimal risk of severe hemorrhage or perforation.

A 15-year series of gastrointestinal non-Hodgkin's lymphomas: a population-based study

“…High-and low-grade NHL types were equally distributed in our series, which is in agreement with other studies (Dworkin et al, 1982;Gobbi et al, 1990). As for subtypes, the distribution of lowgrade NHL was similar to that of other series, the most common types being the lymphoplasmocytoid and the diffuse centroblastic-centrocytic forms (Lennert et al, 1975;Aozasa et al, 1988).…”

“…Although the stomach is the most common location of gastrointestinal NHL, with proportions as high as 80% in some hospital series (Lewin et al, 1978;Rambaud, 1983;Williamson et al, 1983;Aozasa et al, 1988;List et al, 1988;Gobbi et al, 1990), NHL represents only 4% of all gastric malignancies, whereas it accounts for almost 20% of small bowel neoplasms. These data are only typical of those from western nonLatin European countries or from North America.…”

Pri̇mer Gastri̇k Lenfomalar

“…Kemik iliği biyopsisi, lenfangiografisi, akciğer grafisi, abdominal bilgisayarlı tomografi ve mümkünse çölyak, mezenterik, paraaortik ve ilyak lenf nodları biyopsisi alınmalı ve dikkatli bir şekilde değerlendirilerek doğru evreleme yapılmalıdır (4).Ancak Evre l'de doktora başvuranların oranı genellikle %20'yi pek geç-mez (19,23). EVRELEME iyi bir evreleme sistemi hastalığın yeri ve yayı11-lımına göre prognostik bilgileri de vermelidir.…”

“…Isaacson ve VVright, MALT lenfoma gelişiminde öncülük eden spesifik lenfoid dokunun, dış çevre-den kaynaklanan antijenlerle direkt kontak sonucunda permeabl olan mukozal alanlarda geliştiğini göstermişlerdir (23).…”

“…MALT lenfoma, sentrosit benzeri hücrelerin extranodal alanda lenfoepiteliyal lezyon oluşturması ile karekterizedir (32).Gastrik MALT lenfomanın en önemli histopatolojik görünümü lenfoepiteliyal lezyonların varlığıdır.Bu lezyonlar agregasyona uğra-mış ve kümeler oluşturmuş lenfoma hücrelerinin, yani sentrosit benzeri hücrelerin glandüler dokuyu infiltre etmesi ve bu infiltrasyonun mukozal epitel alanlarına da yayılarak sonunda epitel hücrelerinin harabiyete uğraması ile karekterizedir (23,32).Hp mide mukozasında hücrelerde proliferasyon ile birlikte hem epiteliyal, hem de hematopoetik hücreler-de DNA'da oksidatif bir hasar da oluşturmaktadır. Sonuç olarak glandüler yapılar ve epitel harabiyete uğramaktadır (23,32).…”