The role of surgery in the treatment of gastrointestinal lymphomas other than low-grade MALT lymphomas

Background and Objectives. A bias In clinical investigations on gastrointes tinal lymphomas is the lack of testing the Intention to treat as to resecti on, emergency conditions at presentation and selection brought about by the evaluation of feasibility of surgery. Design and Methods. A prospective study involved 154 patients with gastroin testinal nodular or high-grade MALT lymphomas, 111 with a gastric and 43 wi th an intestinal presentation. The decision to resect or treat conservative ly was left to clinicians, on condition that Et was previously defined for each patient. Results. Failure-free survival was significantly higher in the 106 resected patients than in the 48 unresected ones but did not differ according to ei ther primary intention to treat or emergency surgery/elective treatment. Su rvival was similar in patients operated by choice and in those because of a n emergency. Intentionally unresected patients had a significantly better s urvival than those not undergoing surgery despite the initial intention, fo r a number of clinical reasons. Patients with gastric lymphoma survived lon ger than those with intestinal disease and prognostic factors were analyzed separately in the two groups. The best predictors of prognosis were perfor mance status and serum lactic dehydrogenase level in gastric lymphomas, res ection alone in intestinal ones. Interpretations and Conclusions. The prognosis of gastric lymphomas depends on lymphoma-related factors and not on surgical treatment. The prognosis o f Intestinal ones is exclusively related to surgery. These data support the appropriateness of different clinical approaches to gastric and intestinal lymphomas. (C)2000, Ferrata Stortl Foundation.