Abstracts
1999 Digestive Disease Week

# 2194 SURGICAL RESECTION IMPROVES SURVIVAL IN THE TREATMENT OF EARLY GASTRIC LYMPHOMA.
S Blair, S Shah, W Tamim, R Quinlan, Richard S Swanson, Univ of MA Med Sch, Worcester, MA

The optimal treatment of early gastric lymphoma is unknown. Maor et al. described a 73% 5-year survival rate with chemotherapy+/-radiation without surgery (J Clin Oncol 266,1990);Cogliatti et al. found an 87% 5-year survival rate for patients treated primarily with surgery (Gastroent. 1159,1991). No one has directly compared results of treatment for these different strategies. We reviewed our experience in three teaching hospitals of the University of Massachusetts Medical School to determine the role of surgery for early gastric lymphoma. Statistics were performed using chi square, log rank analysis, and Kaplan-Meier curves when appropriate. Using tumor registry data, 71 patients had treatment of gastric lymphoma at our medical school from 1980 to 1998. Stage on presentation correlated with survival time. Patients most commonly presented with pain (79%), weight loss (36%), or bleeding (26%). 39 patients had early or localized disease and form the basis of further study. Patients who had surgery plus chemotherapy+/-radiation had a 90% 5-year survival rate; patients treated with chemotherapy+/-radiation without surgery had a 55% 5-year survival rate (p<0.01). There was no difference in pre-existing comorbidity between the groups. The majority of patients with localized or early gastric lymphoma who were treated with chemotherapy+/-radiation without surgery were treated as part of one hospital's approach based on the work of Maor et al. Comparing all patients on an intention to treat basis (patients preoperatively thought to have early disease) demonstrated a significant survival advantage with the additiona of surgery to chemotherapy+/-radiation. Because this is an uncommon disease, there have been no randomized studies. Based on our data showing a significant survival advantage when surgery was a component of the treatment plan, surgical resection should be considered an important component of the treatment of early gastric lymphoma.

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