Primary gastric lymphoma--the experience of a general hospital

We analysed 29 consecutive cases of primary gastric lymphoma (20 men and 9 women) treated in our unit between January 1977 and May 1983. Median age was 55 years. Abdominal pain and weight loss were the main presenting symptoms while there was no palpable disease in the majority of cases. Upper gastrointestinal radiology was abnormal, but not diagnostic, in all cases. Endoscopy with multiple biopsies was performed in 22 cases; carcinoma was diagnosed in 11, lymphoma in 8 while no diagnosis was made in 3 cases. Twenty six patients underwent laparotomy. Gastrectomy was performed in twenty while the tumour was unresectable in six. Histology was reported as diffuse in 28 cases (16 histiocytic, 8 lymphocytic and 4 mixed) and nodular (lymphocytic) in one. All our patients received multichemotherapy. Complete remission after 6 courses was documented in 18 patients (62%). Neither perforation nor gastrointestinal bleeding was a problem in our series. Eighty four per cent complete responders are predicted to be alive at 4 years. Advanced stage (II2B and IV) and tumour size greater than 10 cm adversely influenced survival. We suggest that in limited primary gastric lymphoma an attempt at 'curative' surgery combined with multichemotherapy currently gives very promising results.