TOTAL GASTRECTOMY FOR PRIMARY GASTRIC LYMPHOMA AT STAGES IE AND IIE -A PROSPECTIVE-STUDY OF 50 CASES

Background. Treatment of primary gastric lymphoma at Ann Arbor stage L E or IIE is controversial. Randomized trial to compare various modalit ies are not feasible because of the rarity of this disease. We have pr ospectively treated patients by means of primary surgery to achieve co mplete local control and accurate staging. Methods. Between 1987 and 1 995, 50 patients with stage LE or IIE gastric lymphoma were prospectiv ely treated by total gastrectomy with systematic lymphadenectomy. When nodal metastases were histologically confirmed or the resection was n oncurative, chemotherapy was added. Intragastric tumor spread lymph no de metastasis, and treatment results were examined. Results. Resection was potentially curative in 48 cases. There were no operative deaths. Histologically, the middle third of the stomach was most frequently i nvolved. Either the proximal two thirds or the entire stomach was invo lved in 62% of all patients. Lymph node metastasis was demonstrated in 25 patients. The deeper the tumor invasion in the gastric wall, the m ore frequent and distant the nodal involvement. The 5-year survival ra te was 85.6%, excluding one death caused by heart disease. Conclusions . Primary surgery followed by chemotherapy in selected cases is an app ropriate strategy for primary gastric lymphoma in patients in whom thi s regimen can be safely carried out.