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Bleeding, Obstruction, and Perforation in a Series of Patients With Aggressive Gastric Lymphoma Treated With Primary Chemotherapy

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Abstract

Background

The management of patients with gastric lymphoma has evolved, with a shift toward nonsurgical treatment. The rates of surgical complications in patients receiving chemotherapy have been insufficiently studied. The objective of this study was to assess the frequency of bleeding, perforation, and gastric outlet obstruction in patients who received chemotherapy as primary treatment for gastric diffuse large B cell lymphoma (DLBCL).

Methods

We reviewed files of all patients with gastric DLBCL who were diagnosed and treated primarily with chemotherapy in our hospital between 1990 and 2005.

Results

Eighteen (25%) of 73 patients experienced surgical complications, of whom 6 (8%) underwent surgery. Eight patients (11%), six with active lymphoma, experienced gastric bleeding; one required gastrectomy. Eight patients (11%) developed gastric outlet obstruction, of whom three were treated conservatively, three required surgery, one stopped treatment, and one received further chemotherapy. Six of the eight patients had no evidence of active lymphoma at the time of obstruction. Two additional patients underwent gastrectomy due to resistant or relapsed disease. Gastric perforation was not observed. Median survival was 90 months for the entire series, 94 months for patients with gastric outlet obstruction, and 11.5 months for patients with gastric bleeding.

Conclusions

Given the rate of surgical complications, especially gastric bleeding and gastric outlet obstruction, there is still an important role for the surgical consultant in the treatment of patients with gastric DLBCL receiving chemotherapy. Gastric perforation, although frequently cited as a complication, is in fact rarely observed.

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Authors and Affiliations

  1. Department of Hematology, Hadassah Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel, 91120

    Galia Spectre MD, Diana Libster MD, Sigal Grisariu MD, Dina Ben Yehuda MD & Ora Paltiel MDCM

  2. Department of Surgery, Hadassah Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel, 91120

    Zvi Gimmon MD

  3. School of Public Health, Hadassah Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel, 91120

    Ora Paltiel MDCM

  4. Department of Internal Medicine, Hematology Unit, Bikur Cholim Hospital, Jerusalem, Israel

    Nael Da’as MD

Authors
  1. Galia Spectre MD
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  2. Diana Libster MD
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  3. Sigal Grisariu MD
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  4. Nael Da’as MD
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  5. Dina Ben Yehuda MD
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  6. Zvi Gimmon MD
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  7. Ora Paltiel MDCM
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Correspondence to Galia Spectre MD.

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Spectre, G., Libster, D., Grisariu, S. et al. Bleeding, Obstruction, and Perforation in a Series of Patients With Aggressive Gastric Lymphoma Treated With Primary Chemotherapy. Ann Surg Oncol 13, 1372–1378 (2006). https://doi.org/10.1245/s10434-006-9069-x

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  • DOI: https://doi.org/10.1245/s10434-006-9069-x

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