Surgical approaches in primary gastric lymphoma and carcinoma.

Data on 29 patients with primary gastric lymphoma and on 1655 with gastric carcinoma were compared with respect to the local extension and the results of surgery. More than two-thirds of the gastric area was involved due to multiple or widespread lesion in 25.9% and 7.0% of the patients with gastric lymphoma and carcinoma, respectively. Maximum tumor dimension exceeded 10 cm in 33.3% and 9.5% of gastric lymphomas and carcinomas respectively. Involvement of the extra-perigastric lymph nodes was evident in 51.8% and 26.2% of the patients with gastric lymphoma and carcinoma respectively. Therefore, wide and extended resection, including total gastrectomy, would be required more often for the surgical excision of gastric lymphoma. Peritoneal dissemination and liver metastasis were much less common in those patients with gastric lymphoma and hence, benefiting most from surgery. The five year survival rate after curative resection was somewhat better in patients with a gastric lymphoma (79.3% as compared to 65.6%), whereas the prognosis after non-curative surgery was equally unfavorable. Aggressive surgical excision is thus recommended for the treatment of patients with a primary gastric lymphoma.