ROLE OF SURGERY IN PATIENTS WITH PRIMARY NON-HODGKINS-LYMPHOMA OF THESTOMACH - AN OLD PROBLEM REVISITED

The literature after 1980 dealing with the treatment of primary gastri c non-Hodgkin's lymphoma (stages I and II) is reviewed. Gastrectomy is recommended for patients with acute symptoms at presentation or with complications of chemotherapy or radiotherapy. In elective cases, pati ents with stage I disease may be candidates for gastrectomy as a singl e therapy, provided that tumour-free resection margins are achieved. T here is no evidence of substantial benefit from adding postoperative c hemotherapy or radiotherapy after an apparently radical resection. In stage H disease, the best results are achieved with ablative surgery p lus adjuvant therapy. The resection volume should be limited to macros copically involved structures, in principle avoiding total gastrectomy and extensive lymph node dissection, since residual disease may be op timally controlled with radiotherapy or chemotherapy. Primary chemothe rapy, with or without radiotherapy, represents an experimental approac h; the advantages of sparing the stomach must be balanced against the toxicity of an aggressive chemotherapy regimen and the risk of emergen cy operation for iatrogenic complications.