A retrospective study was made using 23 patients treated for primary gastrointestinal lymphoma at the department of surgery, Hanyang University Hospital, from July 1983 to June 1993.
@ES The results were as follows.
@EN 1) Primary gastric lymphoma accounted for 0.65%(10 cases) and leiomyosarcoma for 0.91%(14 cases) of the 1532 cases of gastric cancer studied.
2) The mean age of lymphoma was 49.6 years with a male to female ratio as 3.6:1. The primary sites were stomach in 10 cases(44.1%), small intestine in 8 cases(34.4%), colon in 3 cases(12.9%) and ileocecal area in 2 cases(8.6%).
3) The major symptoms and signs were abdominal pain(73.1%). Indigestion(47.3%), anorexia (38.7%), weight loss(34.4%), constipation(25.8%), hunger pain(12.8%), diarrhea(12.9%) and palpable mass(12.9%). Endoscopic biopsy was the most effective
diagnostic
procedure comparing to other methods.
4) The preoperative complications were gastrointestinal perforation in 5 cases(21.7%), and it occurred at ileum in 4 cases, at stomach in 1 case and gastric hemorrhage in 1 case.
5) The curative resectability of the GI lymphomas was 82.6%(19 cases) and the noncurative resectability was 17.4%(4 cases).
6) The pathologics patterns were histiocytic in 18 cases(78.5%), poorly differentiated lymphocytic in 3 cases and mixed in 2 cases according to the Rappaport classification. The predominant type in the stomach and small intestine was the
histiocytic
pattern but there was no predominace in the colon.
7) The clinical stage was Ⅱin 9 cases(38.6%), I in 7 cases(31.2%) and Ⅲin 7 cases(31.2%).
8) Ten patients(43.5%) were treated with postoperative chemotherapy: MACOP-B in 4 cases, CHOP in 2 cases, CHOP-Bleo in 2 cases, COPP in 1 case and MOPP in 1 case.
9) The postoperative complications included enterocutaneous fistula, leakage from the anstomosis site, wound infection, renal failure, metabolic acidosis and atelectasis. There were nine deaths following the operation of which seven patients were
dead
between 2 and 7 months.
10) the mean survival was 21.3 months and the overall 5-year survival rate by Kaplan-Meier was 43.8%.
11) As for the prognosticatiors, the curability, location, size, multiplicity, pathologic pattern by the Rappaport classification, serosal penetration, regional lymph node involvement, clinical stage by Contreary and chemotherapy were analysed.
Serosal
penetration, regional lymph node involvement, clinical stage of Contreary and chemotherapy affected the prognosis significantly.
As for the serosal penetration, the 5-year survival rate of cases with no penetration(10) was 100% but the 3-year survival rate of cases with penetration(13) was 34.7%(p<0.01).
As for the regional lymph node involvement, the 5-year survival rate of cases with no involvement (8) was in 100% but the 3-year survival rate of cases with invovement(15) was 45.0%(p<0.050).
As for the Contreary classification, the 5 year-survival rate of stage I (7) was 100%, the 3-year survival rate of stage Ⅱ(9) was 66.7%, and the 3-year survival rate of stage Ⅲ(7), 28.5%(p<0.05).
Of the cases that underwent curative resection, chemotherapy was performed in 10 cases and non-chemotherapy in 9cases. The 5-year survival rate of the former was 90.0% and the 3-year survival rate of the latter, 44.4%(p<0.05).
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