Surgical resection improves survival in the treatment of early gastric lymphomas

Gastric lymphomas are a relatively rare form of malignancy and controversy about their optimum treatment still exists. To date, there have been no studies directly comparing results of medical therapy alone versus a combination of surgery plus medical therapy. We reviewed our experience in the three teaching hospitals of the University of Massachusetts Medical School to determine the role of surgery in the management of early gastric lymphoma. Statistics were evaluated by means of chi-square, log-rank, and Kaplan-Meier curve analysis where appropriate. Using tumor registry data, 39 patients were treated for early disease at our medical school from 1980 to 1998. Patients treated with surgery plus chemotherapy and radiation had a 90% 5-year survival compared to patients who received chemotherapy and radiation alone (55% 5-year survival; P < 0.01). When we compared all patients on an intention-to-treat basis (patients preoperatively thought to have early-stage disease), there was still a significant survival benefit with the addition of surgery to their management. Because this is an uncommon disease, there are no large prospective studies examining treatment. Based on our retrospective experience, surgical resection should be considered an important adjunct in the treatment of gastric lymphomas in early-stage disease.