Role of Endosonography in the Surgical Management of Non-Hodgkin's Lymphoma of the Stomach

Abstract

Ten patients with primary gastric non-Hodgkin's lymphoma (NHL) were preoperatively assessed by endoscopic ultrasonography (EUS). Tumor infiltration depth and lymph node involvement were assessed using the TNM classification system. EUS was 80 % accurate in determining the T_L stage and 90 % in detecting lymph node metastases (N_L, stage). Based on the longitudinal tumor extent (antrum to fundus), as assessed by preoperative (n = 10) and additionally, intraoperative EUS (n = 3), partial gastric resection was performed in nine patients and total gastrectomy in one. All resection specimens had tumor-free resection margins (R0 resection rate 100 %). These results were compared to those in 23 patients with gastric NHL operated on prior to the introduction of EUS in the hospital who were comparable with respect to tumor location and extent. In comparison with the ten cases where treatment was guided by EUS, the rate of total gastrectomy was higher (65 % versus 10 %) and the R0 resection rate lower (72 % versus 100 %) in this group of 23 patients. These results show that EUS may play a crucial role in the pre-surgical staging of gastric NHL.