Total gastrectomy for primary gastric lymphoma at stages IE and IIE: a prospective study of fifty cases.

Abstract

Treatment of primary gastric lymphoma at Ann Arbor stage IE or IIE is controversial. Randomized trials to compare various modalities are not feasible because of the rarity of this disease. We have prospectively treated patients by means of primary surgery to achieve complete local control and accurate staging. Between 1987 and 1995, 50 patients with stage IE or IIE gastric lymphoma were prospectively treated by total gastrectomy with systematic lymphadenectomy. When nodal metastases were histologically confirmed or the resection was noncurative, chemotherapy was added. Intragastric tumor spread, lymph node metastasis, and treatment results were examined. Resection was potentially curative in 48 cases. There were no operative deaths. Histologically, the middle third of the stomach was most frequently involved. Either the proximal two thirds or the entire stomach was involved in 62% of all patients. Lymph node metastasis was demonstrated in 25 patients. The deeper the tumor invasion in the gastric wall, the more frequent and distant the nodal involvement. The 5-year survival rate was 85.6%, excluding one death caused by heart disease. Primary surgery followed by chemotherapy in selected cases is an appropriate strategy for primary gastric lymphoma in patients in whom this regimen can be safely carried out.