Treatment of gastric B-cell MALT lymphoma: Value of surgery

The role of the surgery in the treatment of gastric B-cell MALT lymphoma remains controversial. Recent studies report no difference in the long-term survival of patients with early stage disease treated by chemotherapy with or without surgery. Because of the main prognostic factors of gastric B-cell MALT lymphoma are histopathological grading and disease staging, the question is: graded and staged without laparotomy? From 1987 to 1996 17 consecutive patients had surgery for Gastric B-cell MALT lymphoma. Preoperative staging classified 14 patients as Stage IE.2 as Stage IIE, and 1 as stage IVE (according to Mushoff Criteria). All patients received post-operative chemotherapy. None of the 17 patients died and none had complications related to surgical treatment. Staging laparotomy showed that 4 of the 17 patients (23,5%) had been understaged (IE instead IIE) and confirmed 1 at stage IVE. Histological classification showed 4 LG, 11 HG and 2 cases with HG + LG gastric lymphoma classified preoperatively (endoscopy) as LG. We believe that patients with clinical stage IE, IIE1 and IIE2, LG or HG gastric lymphoma should receive surgical resection. Surgery, is the only procedure that permits correct staging thus ensuring appropriate postsurgical treatment, without mortality and morbidity, with a good longterm survival. We agree with others that patients with LG, stage IE and T-1 gastric lymphoma and also patients with stage IIIE and IVE should be operated on only if symptomatic (bleeding or obstruction).