title: Bleeding, obstruction, and perforation in a series of patients with aggressive gastric lymphoma treated with primary chemotherapy.
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.
authors.affiliation: Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120. galia.spectre@gmail.com
authors.forename: Galia
authors.initials: G
authors.lastname: Spectre
authors.forename: Diana
authors.initials: D
authors.lastname: Libster
authors.forename: Sigal
authors.initials: S
authors.lastname: Grisariu
authors.forename: Nael
authors.initials: N
authors.lastname: Da'as
authors.forename: Dina Ben
authors.initials: DB
authors.lastname: Yehuda
authors.forename: Zvi
authors.initials: Z
authors.lastname: Gimmon
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000150:complications / Q000188:drug therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000188:drug therapy*; D013275:Stomach Rupture / Q000209:etiology*; D015996:Survival Rate; D016896:Treatment Outcome