Update of the role of surgery in the multimodal treatment of MALT gastric lymphomas

Background: Primary gastric non-Hodgkin's lymphoma is a well-defined clinicopathological entity with a distinct histological spectrum and indolent course. Its optimal management still remains controversial. In this study we present our experience with surgery being part of the multimodal treatment and we compare our results with those referred to in the world literature. Materials and Methods: Sixty-five patients (37 males, 28 females) with gastric MALT lymphoma were retrospectively analyzed. Forty-seven patients underwent curative resection, eleven received chemotherapy as primary treatment, two patients received radiotherapy before any other treatment and five patients received combined chemo-radiation therapy. Results: For the early stages of the disease (I-II1), radical resection offered a two-year survival rate of 100% and 93%, respectively, and a five-year survival of 85% and 67%, respectively. For those stage I patients, who were managed surgically followed by adjuvant therapy, the two- and five-year survival was 90% and 78%, respectively. For stage II patients for whom chemo-radiation therapy followed surgery, the two- and five-year survival was 88% and 65%, respectively. Conclusion: In view of the results of our study, surgery is an adequate treatment modality for the early stages of the disease. The addition of radiotherapy or chemotherapy does not improve the overall survival. Conversely, for the advanced stages (II2-IV), primary chemotherapy is the best treatment option with surgery being reserved for cytoreduction or chemo-radiotherapy-induced complications.