Surgical Complications in Patients Treated with Chemotherapy for Gastric Diffuse Large B Cell Lymphoma.

The management of patients with gastric lymphoma has undergone significant changes in the past few years, with a shift towards non-surgical treatment. However, surgical complications still occur in patients receiving chemotherapy. The rate of these complications is unknown. Our aim was to assess the frequency of bleeding, perforation and gastric outlet obstruction in patients with gastric diffuse large B cell lymphoma who received chemotherapy as a primary treatment for their disease. In this study we retrospectively reviewed files of patients with gastric diffuse large B cell lymphoma, who were diagnosed and treated in our medical center between 1990 and 2005. Results: 88 patients were diagnosed with gastric diffuse large B cell lymphoma of whom 73 were initially treated with chemotherapy, mainly CHOP or similar regimens. The remaining 15 patients were treated with gastrectomy, irradiation, or died before treatment could be initiated. 69 patients had primary lymphoma of the stomach, 4 had gastric involvement at relapse, one had transformed follicular lymphoma and one had post transplant lymphoma. 18 of 73 (25%) patients experienced surgical complications during the course of their treatment. Seven patients had gastric bleeding, of whom 3 were treated conservatively, one underwent angiography with embolization, one had a gastrectomy, and in two patients treatment was stopped due to bleeding and poor performance status. Nine patients had gastric outlet obstruction, of whom 3 were treated conservatively, 4 required surgery, 1 had repeated endoscopic pneumatic dilatations, and one stopped treatment. Seven of 9 patients had no evidence of active lymphoma at the time of gastric outlet obstruction. Two additional patients underwent gastrectomy, 1 due to resistant disease and 1 for relapsed disease. Gastric perforation was not observed. Overall 6 of 73 (8%) of patients eventually required gastric surgery; 3 are alive and free of disease, one died from lymphoma and two died from other causes. We conclude that there is a substantial rate of surgical complications in patients with gastric diffuse large B cell lymphoma receiving chemotherapy and thus, there is still a major role for the surgical consultant in the treatment of these patients. Gastric perforation is a rare complication.