Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1998 Jan;227(1):45–50. doi: 10.1097/00000658-199801000-00007

The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma.

Y Kodera 1, Y Yamamura 1, S Nakamura 1, Y Shimizu 1, A Torii 1, T Hirai 1, K Yasui 1, T Morimoto 1, T Kato 1, T Kito 1
PMCID: PMC1191171  PMID: 9445109

Abstract

OBJECTIVE: We evaluated the therapeutic efficacy of radical gastrectomy for primary B-cell lymphoma of the stomach and attempted to identify patients who could be adequately treated with surgery alone. SUMMARY BACKGROUND DATA: Several recent gastric lymphoma reports have discussed the therapeutic benefits of various treatment strategies for stage IE and IIE lymphoma. However, few studies have been based on patients accurately staged by systematic lymphadenectomy with subsequent pathologic examination. METHODS: A retrospective study was performed to evaluate the survival and biologic behavior of lesions in 60 patients with gastric lymphoma who were treated by radical gastrectomy alone. Tumors were classified according to the histopathologic concept of mucosa-associated lymphoid tissue (MALT)-derived lymphoma. RESULTS: A low histopathologic grade was associated with a significantly lower incidence of nodal metastasis (p = 0.07) and less extensive infiltration of the gastric wall (p < 0.005) despite larger tumor size. A 5-year survival rate of >95% was attained with surgery alone for MALT lymphoma and for true stage IE lymphoma diagnosed by pathologic examination of up to N2 lymph nodes routinely performed after radical gastrectomy. CONCLUSIONS: Surgery alone is adequate treatment for stage IE or pure MALT lymphoma, provided that the staging is performed after radical gastrectomy.

Full text

PDF
45

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akaza K., Motoori T., Nakamura S., Koshikawa T., Kitoh K., Futamura N., Nakamura T., Kojima M., Kuroda M., Kasahara M. Clinicopathologic study of primary gastric lymphoma of B cell phenotype with special reference to low-grade B cell lymphoma of mucosa-associated lymphoid tissue among the Japanese. Pathol Int. 1995 Nov;45(11):832–845. doi: 10.1111/j.1440-1827.1995.tb03403.x. [DOI] [PubMed] [Google Scholar]
  2. Bozzetti F., Audisio R. A., Giardini R., Gennari L. Role of surgery in patients with primary non-Hodgkin's lymphoma of the stomach: an old problem revisited. Br J Surg. 1993 Sep;80(9):1101–1106. doi: 10.1002/bjs.1800800908. [DOI] [PubMed] [Google Scholar]
  3. Bunt A. M., Hermans J., Boon M. C., van de Velde C. J., Sasako M., Fleuren G. J., Bruijn J. A. Evaluation of the extent of lymphadenectomy in a randomized trial of Western- versus Japanese-type surgery in gastric cancer. J Clin Oncol. 1994 Feb;12(2):417–422. doi: 10.1200/JCO.1994.12.2.417. [DOI] [PubMed] [Google Scholar]
  4. Bunt A. M., Hermans J., Smit V. T., van de Velde C. J., Fleuren G. J., Bruijn J. A. Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol. 1995 Jan;13(1):19–25. doi: 10.1200/JCO.1995.13.1.19. [DOI] [PubMed] [Google Scholar]
  5. Carbone P. P., Kaplan H. S., Musshoff K., Smithers D. W., Tubiana M. Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res. 1971 Nov;31(11):1860–1861. [PubMed] [Google Scholar]
  6. Castrillo J. M., Montalban C., Obeso G., Piris M. A., Rivas M. C. Gastric B-cell mucosa associated lymphoid tissue lymphoma: a clinicopathological study in 56 patients. Gut. 1992 Oct;33(10):1307–1311. doi: 10.1136/gut.33.10.1307. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cogliatti S. B., Schmid U., Schumacher U., Eckert F., Hansmann M. L., Hedderich J., Takahashi H., Lennert K. Primary B-cell gastric lymphoma: a clinicopathological study of 145 patients. Gastroenterology. 1991 Nov;101(5):1159–1170. doi: 10.1016/0016-5085(91)90063-q. [DOI] [PubMed] [Google Scholar]
  8. DeLellis R. A., Sternberger L. A., Mann R. B., Banks P. M., Nakane P. K. Immunoperoxidase technics in diagnostic pathology. Report of a workshop sponsored by the National Cancer Institute. Am J Clin Pathol. 1979 May;71(5):483–488. doi: 10.1093/ajcp/71.5.483. [DOI] [PubMed] [Google Scholar]
  9. Feinstein A. R., Sosin D. M., Wells C. K. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985 Jun 20;312(25):1604–1608. doi: 10.1056/NEJM198506203122504. [DOI] [PubMed] [Google Scholar]
  10. Hammel P., Haioun C., Chaumette M. T., Gaulard P., Divine M., Reyes F., Delchier J. C. Efficacy of single-agent chemotherapy in low-grade B-cell mucosa-associated lymphoid tissue lymphoma with prominent gastric expression. J Clin Oncol. 1995 Oct;13(10):2524–2529. doi: 10.1200/JCO.1995.13.10.2524. [DOI] [PubMed] [Google Scholar]
  11. Hayes J., Dunn E. Has the incidence of primary gastric lymphoma increased? Cancer. 1989 May 15;63(10):2073–2076. doi: 10.1002/1097-0142(19890515)63:10<2073::aid-cncr2820631033>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  12. Hockey M. S., Powell J., Crocker J., Fielding J. W. Primary gastric lymphoma. Br J Surg. 1987 Jun;74(6):483–487. doi: 10.1002/bjs.1800740620. [DOI] [PubMed] [Google Scholar]
  13. Jatzko G. R., Lisborg P. H., Denk H., Klimpfinger M., Stettner H. M. A 10-year experience with Japanese-type radical lymph node dissection for gastric cancer outside of Japan. Cancer. 1995 Oct 15;76(8):1302–1312. doi: 10.1002/1097-0142(19951015)76:8<1302::aid-cncr2820760803>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  14. Maor M. H., Velasquez W. S., Fuller L. M., Silvermintz K. B. Stomach conservation in stages IE and IIE gastric non-Hodgkin's lymphoma. J Clin Oncol. 1990 Feb;8(2):266–271. doi: 10.1200/JCO.1990.8.2.266. [DOI] [PubMed] [Google Scholar]
  15. Nakamura S., Akazawa K., Yao T., Tsuneyoshi M. A clinicopathologic study of 233 cases with special reference to evaluation with the MIB-1 index. Cancer. 1995 Oct 15;76(8):1313–1324. doi: 10.1002/1097-0142(19951015)76:8<1313::aid-cncr2820760804>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  16. Noguchi Y., Imada T., Matsumoto A., Coit D. G., Brennan M. F. Radical surgery for gastric cancer. A review of the Japanese experience. Cancer. 1989 Nov 15;64(10):2053–2062. doi: 10.1002/1097-0142(19891115)64:10<2053::aid-cncr2820641014>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  17. Pedersen-Bjergaard J., Ersbøll J., Hansen V. L., Sørensen B. L., Christoffersen K., Hou-Jensen K., Nissen N. I., Knudsen J. B., Hansen M. M. Carcinoma of the urinary bladder after treatment with cyclophosphamide for non-Hodgkin's lymphoma. N Engl J Med. 1988 Apr 21;318(16):1028–1032. doi: 10.1056/NEJM198804213181604. [DOI] [PubMed] [Google Scholar]
  18. Pedersen-Bjergaard J., Ersbøll J., Sørensen H. M., Keiding N., Larsen S. O., Philip P., Larsen M. S., Schultz H., Nissen N. I. Risk of acute nonlymphocytic leukemia and preleukemia in patients treated with cyclophosphamide for non-Hodgkin's lymphomas. Comparison with results obtained in patients treated for Hodgkin's disease and ovarian carcinoma with other alkylating agents. Ann Intern Med. 1985 Aug;103(2):195–200. doi: 10.7326/0003-4819-103-2-195. [DOI] [PubMed] [Google Scholar]
  19. Rackner V. L., Thirlby R. C., Ryan J. A., Jr Role of surgery in multimodality therapy for gastrointestinal lymphoma. Am J Surg. 1991 May;161(5):570–575. doi: 10.1016/0002-9610(91)90902-p. [DOI] [PubMed] [Google Scholar]
  20. Rosen C. B., van Heerden J. A., Martin J. K., Jr, Wold L. E., Ilstrup D. M. Is an aggressive surgical approach to the patient with gastric lymphoma warranted? Ann Surg. 1987 Jun;205(6):634–640. doi: 10.1097/00000658-198706000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Schwarz R. J., Conners J. M., Schmidt N. Diagnosis and management of stage IE and stage IIE gastric lymphomas. Am J Surg. 1993 May;165(5):561–565. doi: 10.1016/s0002-9610(05)80435-0. [DOI] [PubMed] [Google Scholar]
  22. Shepherd F. A., Evans W. K., Kutas G., Yau J. C., Dang P., Scott J. G., Farquharson H. A., Francombe W. H., Bailey D., Baker M. A. Chemotherapy following surgery for stages IE and IIE non-Hodgkin's lymphoma of the gastrointestinal tract. J Clin Oncol. 1988 Feb;6(2):253–260. doi: 10.1200/JCO.1988.6.2.253. [DOI] [PubMed] [Google Scholar]
  23. Sheridan W. P., Medley G., Brodie G. N. Non-Hodgkin's lymphoma of the stomach: a prospective pilot study of surgery plus chemotherapy in early and advanced disease. J Clin Oncol. 1985 Apr;3(4):495–500. doi: 10.1200/JCO.1985.3.4.495. [DOI] [PubMed] [Google Scholar]
  24. Shimodaira M., Tsukamoto Y., Niwa Y., Goto H., Hase S., Hayakawa T., Nagasaka T. A proposed staging system for primary gastric lymphoma. Cancer. 1994 Jun 1;73(11):2709–2715. doi: 10.1002/1097-0142(19940601)73:11<2709::aid-cncr2820731110>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  25. Siewert J. R., Böttcher K., Roder J. D., Busch R., Hermanek P., Meyer H. J. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg. 1993 Aug;80(8):1015–1018. doi: 10.1002/bjs.1800800829. [DOI] [PubMed] [Google Scholar]
  26. Stolte M., Eidt S. The diagnosis of early gastric lymphoma. Z Gastroenterol. 1991 Jan;29(1):6–10. [PubMed] [Google Scholar]
  27. Taal B. G., Burgers J. M. Primary non-Hodgkin's lymphoma of the stomach: endoscopic diagnosis and the role of surgery. Scand J Gastroenterol Suppl. 1991;188:33–37. doi: 10.3109/00365529109111227. [DOI] [PubMed] [Google Scholar]
  28. Talamonti M. S., Dawes L. G., Joehl R. J., Nahrwold D. L. Gastrointestinal lymphoma. A case for primary surgical resection. Arch Surg. 1990 Aug;125(8):972–977. doi: 10.1001/archsurg.1990.01410200030003. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES