Diagnosis And Surgical Treatment Of Primary Gastrointestinal Lymphoma: An Analysis Of 67 Cases

Objective:To investigate the diagnosis,treatment and prognosis of Primary Gastrointestinal Lymphoma,improve the diagnostic rate,and standard treatment.Methods:Sixty seven PGIL patients were collect from January 1999 to January 2010 admitted to General surgery Department of the first affiliated hospital of Dalian Medical University,and their retrospective study and analysis.Results:Clinicopathologic data about 67 surgically treated PGIL patients (35 males and 32 females)at the median age of 53.5 years (range 22-79 years)were retrospectively analyzed.The most common initial clinical features of the patients were abdominal pain (71.64%), weight loss (41.8%), abdominal distention (25.37%), discomfort (28.36%), melena (19.4%), anti-acid (19.4%), belching (17.91%), nausea (11.95%), vomiting (11.95%), fatigue(8.96%),appetite decreased (7.46%),fever(5.97%). Histopathological examination revealed that mucosa-associated lymphoid tissue (MALT) lymphoma,accounted for the largest proportion of the patients,of 53.74%, followed by diffuse large B-cell lymphoma (DLBCL),of 44.78%.The preoperative misdiagnosic rate was 65.67%.the diagnostic rate of the following accessory examinations are X-ray contrast radiography 10%,CT 15.91%,gastrointestinal endoscopy 33%.58 patients in this group were treated with operation,38 patients received chemotherapy after operation. The 1-year survival rate and the 5-year survival rate of this group are 82.8% and 58.6%.The differences of 1-year,5-year survival rate between male group and female group didn' t have statistical significance (P>0.05).The differences of 1-year,5-year survival rate between the group aged over 50 years and the group younger than 50 years old didn't have statistical significance(P>0.05).The differences of 1-year,5-year survival rate between the group of tumor in the stomach and the group of tumor in the intestinal had statistical significance (P<0.05). The differences of 1-year,5-year survival rate between the group of tumor diameter bigger than 10cm and the group of tumor diameter less than 10cm had statistical significance (P＜0.05). The differences of 1-year,5-year survival rate between serosa invasion group and no serosa invasion group had statistical significance (P<0.05). The differences of 1-year,5-year survival rate between stage I and stage II didn't have statistical significance(P>0.05).The differences of 1-year,5-year survival rate between stageⅠ+Ⅱand stageⅢ+Ⅳhad statistical significance (P＜0.05). The differences of 5-year survival rate between the post-operative comprehensive treatment group and only operation group had statistical significance (P＜0.05).Conclusion:PGIL is a rare disease.Clinicians lacked of knowledge on PGIL.Most PGIL patients have nonspecific clinical symptoms and signs.The rate of clinical misdiagnosis was high.Preoperative diagnosis was difficult. X-ray,CT,endoscopic ultrasonography and immunohistochemistry may improve the diagnostic rate.Disease size,pathological type,tumor size,the depth of invation and clinical stage are close related with prognosis. Post-operative comprehensive treatment can increase survival rate clearly.