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Review
. 2004 Jul;240(1):28-37.
doi: 10.1097/01.sla.0000129356.81281.0c.

The diminishing role of surgery in the treatment of gastric lymphoma

Sam S Yoon  1 , Daniel G Coit, Carol S Portlock, Martin S Karpeh
Affiliations
Review

The diminishing role of surgery in the treatment of gastric lymphoma

Sam S Yoon et al. Ann Surg. 2004 Jul.

Abstract

Objective: This article reviews the pathogenesis, diagnosis, and treatment of patients with primary gastric lymphoma, with special attention to the changing role of surgery.

Summary background data: Primary gastric lymphomas are non-Hodgkin lymphomas that originate in the stomach and are divided into low-grade (or indolent) and high-grade (or aggressive) types. Low-grade lesions nearly always arise from mucosa-associated lymphoid tissue (MALT) secondary to chronic Helicobacter pylori (H. pylori) infection and disseminate slowly. High-grade lesions may arise from a low grade-MALT component or arise de novo and can spread to lymph nodes, adjacent organs and tissues, or distant sites.

Methods: A review of the relevant English-language articles was performed on the basis of a MEDLINE search from January 1984 to August 2003.

Results: About 40% of gastric lymphomas are low-grade, and nearly all these low-grade lesions are classified as MALT lymphomas. For low-grade MALT lymphomas confined to the gastric wall and without certain negative prognostic factors, H. pylori eradication is highly successful in causing lymphoma regression. More advanced low-grade lymphomas or those that do not regress with antibiotic therapy can be treated with combinations of H. pylori eradication, radiation therapy, and chemotherapy. Nearly 60% of gastric lymphomas are high-grade lesions with or without a low-grade MALT component. These lymphomas can be treated with chemotherapy and radiation therapy according to the extent of disease. Surgery for gastric lymphoma is now often reserved for patients with localized, residual disease after nonsurgical therapy or for rare patients with complications.

Conclusion: The treatment of gastric lymphoma continues to evolve, and surgical resection is now uncommonly a part of the initial management strategy.

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Figures

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FIGURE 1. Primary gastric lymphoma according to grade.
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FIGURE 2. Histologic slides of gastric lymphoma. (A) Low-grade MALT lymphoma showing infiltration of lymphoid cells and destruction of gastric glands. (B) High-grade lymphoma showing sheets of transformed blast cells.
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FIGURE 3. Algorithm for management of primary gastric lymphoma. (A) Low-grade; (B) high-grade.
See this image and copyright information in PMC

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