The changing role of staging laparotomy in Hodgkin's disease: A personal series of 310 patients

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Abstract
A series of 310 patients with Hodgkin's disease having a staging laparotomy under the care of one surgeon (J-C. G.) between October 1969 and June 1980 is presented. A total of 51 per cent had positive laparotomy findings, and 30 per cent had their staging altered, but there was a low incidence of positive laparotomy findings when performed within 2 months of initial treatment by chemotherapy. None of the investigations used to determine possible splenic or hepatic involvement preoperatively was found to be of any value, and their routine use is not recommended. Bipedal lymphography was found to give an accurate assessment of iliac and lower para-aortic nodal involvement, and so the laparotomy protocol since 1975 has not included biopsy of these nodes. The incidence of minor complications was 31 per cent and of major complications 4 per cent. One patient died. Staging laparotomy has played an important part in the management of Hodgkin's disease over the past decade, but it is likely to assume a less prominent role in the 1980s as the role of chemotherapy in early Hodgkin's disease expands. In non-bulky clinical stage I and II Hodgkin's disease, when radiotherapy alone is curative, then a staging laparotomy is justifiable because it will detect occult abdominal disease, especially in the lymphogram-negative patient, which may require the addition of chemotherapy or more extensive radiotherapy. Laparotomy is essentially an operation to remove the spleen and to obtain adequate liver biopsy specimens in order to ascertain possible involvement of these two organs. Non-opacified nodes at the porta hepatis and coeliac axis should also be sampled, as should a node from the poorly opacified upper paraaortic area. Routine oophoropexy is not recommended.