[Current problems in the surgical treatment of primary lymphoma of the stomach]

The surgical treatment of the primary gastric lymphoma (P.G.L.) presents some controversial aspects still. The authors discuss the problem on the basis of the most recent data published in the literature and on their own experience concerning 14 cases of P.G.L. They confirm that surgery maintains an important role, at first, in the determination of the diagnosis exactly. The incidence of preoperative diagnosis of P.G.L. is unsatisfactory still, although increasing with the appropriate technique of endoscopic biopsies and modern immunohistochemical analysis. Moreover, the surgical approach is necessary for the definitive staging of the disease, which at the laparotomy, must be performed with these modalities: gastrectomy, regional and extra-regional lympho-adenectomy, fine needle aspiration and surgical biopsy of the liver. The extension of the gastrectomy is based on the location of the tumor. In the P.G.L. localized in the middle and in the upper stomach a total gastrectomy must be performed; on the contrary in a neoplasm localized in the lower part, a subtotal gastrectomy could be considered as a curative treatment. Integrated with chemotherapy, surgery offers appreciable results in long term survival, much better than those obtained after surgical treatment of gastric cancer.