Gastrointestinal lymphoma: a surgical perspective.

The incidence of gastrointestinal lymphoma, especially gastric lymphoma, has increased threefold since 1960. The stomach is affected most frequently, followed by the small bowel and colon. Gastric lymphoma can be diagnosed using endoscopic biopsies in about 80% of cases. Small bowel and colonic lymphomas are usually diagnosed at operation. The most important factors affecting survival are pathologic stage and nuclear grade. Since about half of gastric lymphomas are low grade, but virtually all small bowel lymphomas are high grade, survival in patients with gastric lymphomas, as a group, is better than that in patients with small bowel lymphomas. Most series have found that surgical resection provides a marked survival advantage. However, no controlled trials have determined the optimal treatment for these patients. In addition to surgical resection, virtually all patients should receive adjuvant chemotherapy and/or radiotherapy. For gastric lymphomas, average 5-year survival rates by stage are about 85% (stage IE), 65% (stage IIE), and 25% (stage IVE).