Gastric and small bowel lymphoma

Despite the vague presentation of gastric and small bowel lymphoma, survival can be achieved by adequate surgical resection of stage I disease. A role still exists for debulking of advanced stage disease by surgical excision. Debulking enhances potential for complete response with chemotherapy, decreases the risk of gastric and small bowel perforation with large exophytic tumors as they necrose with chemotherapy, and prevents gastrointestinal obstruction from limiting patients' ability to receive chemotherapy. All attempts should be made to maintain nutritional support of these patients to allow them an adequate chance of receiving chemotherapy. The increasing frequency of immunodeficiency disorders will continue to produce higher numbers of patients with non-Hodgkin's lymphoma. Awareness of our surgical limitations is important because surgical exploration is frequently the first step. Multimodality therapy of gastric and small bowel lymphoma offers the best chance for successful outcome. Surgical resection should not prevent patients from receiving a complete trial of chemotherapy and radiation if appropriate.