The Role of D2 Gastrectomy for the Treatment of Primary Gastric Lymbhoma: 9- Year Experience at Ramathibodi Hospital


  • Chakrapan Euanorasetr Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok


Background: Primary gastric lymphoma (PGL) is a relatively rare disease. Several reports have discussed the therapeutic benefit of various treatment strategies for PGL. The role of surgery in the management of localized PGL remains controversial. However, few studies have been based on patients accurately staged by systematic lymph node dissection.

Objective: The aim of this study was to evaluate the therapeutic efficacy of D2 gastrectomy with curative intent for PGL. This is the first report of the result of D2 gastrectomy for PGL in Thai patients.

Materials and Methods: We retrospectively reviewed the clinicopathologic features, surgical outcome, morbidity and mortality in 12 patients with PGL who underwent D2 gastrectomy with curative intent during the period between May 1995 and October 2003.

Results: Diffuse large cell Iymphomas in this homogenous group of patients were all localized diseases (stage I, II1 or IIE), Endoscopic biopsies revealed malignant lymphoma in only 6 patients (50%), Total gastrectomy and subtotal gastrectomy was each performed in 6 patients. Five patients underwent D2 gastrectomy alone, whereas seven patients received postoperative adjuvant chemotherapy. The morbidity rate was 25% and there was no operative death. The median follow-up time was 60.4 months (ranged 24-103 months). At the last follow-up period of at least 2 years after surgery, all patients were still alive. Ten patients (83.3%) were alive without disease and 2 patients (16.7%) were alive with disease relapse.

Conclusion: The results suggest that surgery remains the appropriate frontline therapy for localized PGL.


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1. Stephens J, Smith J. Treatment of primary gastric lymphoma and gastric mucosa-associated lymphoid tissue lymphoma. J Am Coll Surg 1998: 187: 312-20.

2. Mafune KI, Tanaka Y, Suda Y, et al. Outcome of patients with non-Hodgkin's lymphoma of the stomach after gastrectomy. Clinicopathologic study and reclassification according to the revised European-American lymphoma classification. Gastric Cancer 2001: 4:137-43.

3. AI-Akwaa AM, Siddiqui NE, A-Moflech IA. Primary gastric lymphoma. World J Gastroenterol 2004; 10: 5-1 1.

4. Bozzetti F, Audisio RA, Giardini R, et al. Role of surgery in patients with primary non-Hodgkin's lymphoma of the stomach: an old problem revisited. Br J Surg 1993; 80:1101-6

5. Armitage JO. Staging Non-Hodgkin lymphoma. CA Cancer J Clin 2005;55:368-76.

6. Ranaldi R, Goteri G, Baccarini MG, et al. A clinicopathological study of 152 surgically treated primary gastric lymphomas with survival analysis of 109 high grade tumors. J Clin Pathol 2002;55: 346-51.

7. Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution. Clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001; 19: 3861-73.

8. Popesco RA, Wotherspon AC, Cunningham D, et al. Surgery plus chemotherapy or chemotherapy alone for primary intermediate- and high-grade gastric non-Hodgkin's lymphoma. The Royal Marsden experience. Eur J Cancer 1999;35:928-34.

9. Bozer M, Eroglu A, Unal E, et al. Survival after curative resection for stage IE and II E primary gastric lymphoma. Hepatogastroenterology 2001; 48:1202-5.

10. Zeid MA, Elbedewy AF, Awad I. Primary gastric lymphoma: a clinicopathologic study. Hepatogastroenterology 2005;52:649-53.

11. Ishizuka H, Kubota J, Hayashi N, et al. Management of primary gastric lymphoma from a surgeon's viewpoint. Oncol Rep 1999; 6:103-6.

12. Blair S, Shab S, Tamim W, et al. Surgical resection improves survival in the treatment of early gastric lymphomas. J Gastrointest Surg 2000; 4: 304-9.

13. Steinau G, Riesener KP, Schleef J, et al. Primary Non-Hodgkin lymphoma of the stomach - role of surgery. Hepatogastroenterology 1997: 44: 1513-7.

14. Kang YK, Kim CW, Kim WH, et al. Primary malignant lymphomas of the stomach. J Kor Med Sci 1996; 11: 480-8.

15. Kitamura K, Yamaguchi T, Okamoto K, et al. Early gastric lymphoma: a clinicopathological study of ten patients, literature review, and comparison with early gastric adenocarcinoma. Cancer 1996; 77: 850-7.

16. Speranza V, Lomanto D, Meli EZ, et al. Primary gastric lymphoma: a 15-year review. Hepatogastroenterology 1995;42:371-6.

17. Schwarz RJ, Conners JM, Schmidt N. Diagnosis and management of stage IE and stage IIE gastric lymphomas. Am J Surg 1993; 165: 561-5.

18. Ducreux M, Boutron MC, Piard F, et al. A 15-year series of gastrointestinal non-Hodgkin's lymphomas: a population-based study. Br J Cancer 1998; 77: 511-4.

19. Binn M, Ruskone-Fourmestraux A, Lepage E, et al. Surgical resection plus chemotherapy versus chemotherapy alone; comparison of two strategies to treat diffuse large B-cell gastric lymphoma. Ann Oncol 2003; 14: 1751-7.

20. Severson RK, Davis S. Increasing incidence of primary gastric lymphoma. Cancer 1990;66:1283-7.

21. Kodera Y, Yamamura Y, Nakamura S, et al. The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma. Ann Surg 1998; 227: 45-50.

22. Koniasis LG, Drugas G, Katzman P, et al. Management of gastrointestinal lymphoma. J Am Coll Surg 2003; 197:127-41.

23. Rodrigues-Sanjuan JC, Alvarez-Canas C, Casado F, et al. Results and prognostic factors in stage IE-IIE primary gastric lymphoma after gastrectomy. J Am Coll Surg 1999; 188:296-303.

24. Takenaka T, Maruyama K, Kinoshita T, et al. A prospective study of surgery and adjuvant chemotherapy for primary gastric lymphoma stage II. Br J Cancer 1997;76: 1484-8.

25. Bartlett D, Karpeh M, Filippa D, et al. Long-term follow-up after curative surgery for early gastric lymphoma. Ann Surg 1996;223:53-62.

26. Takahashi I, Maehara Y, Koga T, et al. Role of Surgery in the patients with stage I and ll primary gastric lymphoma. Hepatogastroenterology 2003; 50: 877-82.

27. Weisberg J, Bromberg SH, Franco MIF, et al. The role of surgery in the treatment of primary gastric lymphoma. Int Surg 2000; 85: 219-25.

28. Sano T, Sasako M, Kinoshita, et al. Total gastrectomy for primary gastric lymphoma at stages IE and IIE: a prospective study of fifty cases. Surgery 1997; 121: 501-9.

29. Vaillant JC, Ruskone-Fourmestraux A, Aegerter P, et al. Management and long-term results of surgery for localized gastric lymphomas. Am J Surg 2000; 179: 216-22.

30. Caronna R, Cardi M, Martell M, et al. Systematic radical gastrectomy and D2 lymphadenectomy in primary gastric B cell lymphoma: impact on diagnosis, classification and long term results. A prospective study. J Chemother 2004;16:26-9.

31. Fischbach W, Dragosics B, Kolve-Goedeler ME, et al. Primary gastric B-cell lymphoma. Results of a prospective multicenter study, Gastroenterology 2001; 119: 1191-201.

32. Kelessis NG, Vassilopoulos PP, Bai MP, et al, Update of the role of surgery in the multimodal treatment of MALT gastric lymphomas. Anticancer Res 2002; 22: 3457-63.

33. Makela J, Karttunen J, Kiviniemi H, et al. Clinicopathological features of primary gastric lymphoma. J Surg Oncol 1999;70:78-82.

34. Salvagno L, Soraru M, Busetto M, et al. Gastric non-Hodgkin's lymphoma: analysis of 252 patients from a multicenter study. Tumori 1999; 85: 113-121.

35. Jelie S, Kovein V, Jovanosic V, et al. Primary gastric non-Hodgkin's lymphoma, localized to the gastric wall : no adjuvant treatment following radical surgery. Oncology 1994; 51:270-2.

36. Cogliatti SB, Schmid U, Schumacher UE, et al. Primary B-cell gastric lymphoma: a clinicopathological study of 145 patients. Gastroenterology 1991; 101:1159-70.

37. Zinzani PL, Frezza G, Bendandi M, et al. Primary gastric lymphoma: a clinical and therapeutic evaluation of 82 patients. Leuk Lymphoma 1995; 19: 461-6.

38. Maor MH, Maddux B, Osborne BM, et al. Stages IE and IIE non-Hodgkin's lymphomas of the stomach. Comparison of treatment modalities, Cancer 1984; 54: 2330-7.

39. Koch P, del Valle F, Bersel WE, et al. Primary gastrointestinal non-Hodgkin's Iymphomas. Il: combined surgical and conservative management only in localized gastric lymphoma. Results of the prospective German Multicentre Study GIT NHL 01/92. J Clin Oncol 2001; 18: 3874-87.

40. Willich NA, Reinartz G, Horst EJ, et al. Operative and conservative management of primary gastric lymphoma. Interim results of a German multicanter study. Int J Radiation Oncology Biol Phys 2000; 46: 895-901.

41. Liu HT, Hsu C, Chen CL, et al. Chemotherapy alone versus surgery followed by chemotherapy for stage I/IIE large-cell lymphoma of the stomach. Am J Hematol 2000; 64: 175-9.

42. Tanaka Y, Takao T, Watanabe H, et al, Early stage gastric lymphoma: is operation essential? World J Surg 1994; 18: 896-9.

43. Raderer M, Valencak J, Osterreicher C, et al. Chemotherapy for the treatment of patients with primary high grade gastric B-cell lymphoma of modified Ann Arbor stages IE and II E. Cancer 2000;8 8:1979-85.

44. Plytel J, Sigon R, Bidoli E, et al. Primary gastric non-Hodgkins lymphoma - does surgery still play any role, Eur J Surg Oncol 1994;20:525-36.

45. Dawson IMP, Cornes Js, Morson BC. Primary malignant lymphoid tumours of the intestinal tract. Br J Surg 1961; 49:80-9.

46. Jaffe ES, Harris NL, Diebold J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. A progress report. Am J Clin Pathol 1999;111: S8-S12.

47. Rohatainer A, Report on a workshop convened to discuss the pathological and staging classification of gastrointestinal tract lymphoma. Ann Oncol 1994:5: 397-400.

48. Euanorasetr C. How I do it: Radical gastrectomy for gastric adenocarcinoma. In: Vasanasiri W, editor. Surgical Oncology I, Bangkok: Kosit Publishing; 2005. p. 97-105.

49. Euanorasetr C. Surgical techniques of gastric cancer surgery. In: Wongkietkajorn S, editor. Surgery Vol. 30. Bangkok: Kosit Publishing; 2005. p. 181-206.

50. Euanorasetr C. Radical gastrectomy for gastric carcinoma. In: Kitisin P, editor. Surgery Vol. 15. Bangkok; Bangkok Medical Publisher; 1997, p. 114-48.

51. Maruyama K, Sasako M, Kinoshita T, et al. Pancreas preserving total gastrectomy for proximal gastric carcinoma. World J Surg 1995: 19: 532-6.

52. Yoon SS, Coit DG, Portlock Cs, et al. The diminishing role of surgery in the treatment of gastric lymphoma. Ann Surg 2004;240:28-37.

53. Brands F, Monig SP, Raab M, Treatment and prognosis of gastric lymphoma. Eur J Surg 1997; 163: 803-13.

54. Aviles A, Nambo MJ, Neri N, et al. The role of surgery in primary gastric lymphoma. Results of a controlled clinical trial. Ann Surg 2004; 240: 44-50.

55. Kodera Y, Yamamura Y, Nakamura S, et al. The role of radical gastrectomy with systematic lymphadenectomy for the diagnosis and treatment of primary gastric lymphoma. Ann Surg 1998; 227: 45-50.

56. Lin KM, Penney DG, Mahmoud A, et al: Advantage of surgery and adjuvant chemotherapy in the treatment of primary gastrointestinal lymphoma. J Surg Oncol 1997; 64: 237-41.

57. Ruskone-Fourmestraux A, Aegerter P, Delmer A, et al, Primary digestive tract lymphoma: a prospective multicentric study of 91 patients. Groupe d'Etude des Lymphomas Digestifs Gastroenterology 1993; 105: 1662-71.

58. Tondini C, Giardini R, Bozzetti F, et al. Combined modality treatment for primary gastrointestinal non-Hodgkin's lymphoma: the Milan Cancer Institute experience. Ann Oncol 1993; 4:831-7.

59. Rigacci L, Bellesi G, Alterini R, et al. Combined surgery and chemotherapy in primary gastric non-Hodgkin's lymphoma: a retrospective study in sixty-six patients. Leuk Lymphoma 1994;14:483-9.

60. Brincker H, F DA. A retrospective analysis of treatment outcome in 106 cases of localized gastric non-Hodgkin lymphomas. Danish Lymphoma Study Group, LYFO, Leuk Lymphoma 1995;18: 281-8.

61. Koch P, Probst A, Berdel WE, et al. Treatment results in localized primary gastric lymphoma: Data of patients registered within the German Multicenters study (GIT NHL 02/96), J Clin Oncol 2005; 23: 7050-9.

62. de Jong D, Aleman BM, Taal BG, et al. Controversies and consensus in the diagnosis, work-up and treatment of gastric lymphoma: an international survey. Ann Oncol 1999; 10: 275-8.

63. Pedersen-Bjergaard J, Ersboll J, Sorensen HM, et al. Risk of acute nonlymphocytic leukemia and preleukemia in patients treated with cyclophosphamide for non-Hodgkin's lymphomas. Ann Intern Med 1985: 103: 195-200.

64. Pedersen-Bjergaard J, Ersboll J, Hansen VL, et al. Carcinoma of the urinary bladder after treatment with cyclophosphamide for non-Hodgkin's lymphoma. N Engl J Med 1988;318:1028-32.




How to Cite

Euanorasetr C. The Role of D2 Gastrectomy for the Treatment of Primary Gastric Lymbhoma: 9- Year Experience at Ramathibodi Hospital. Thai J Surg [Internet]. 2006 Jun. 30 [cited 2022 Oct. 1];27(2):84-92. Available from:



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