Laparoscopic interventions in lymphoma management

The widespread use of laparoscopy has been made possible by the exponential improvements in imaging technology as well as the development of specialized instruments. Although the use of laparoscopy for procedures such as cholecystectomy has become commonplace, its applicability in the management of malignancies remains in evolution. The role of the surgeon in the care of the patient with lymphoma is limited mostly to obtaining a diagnosis. Laparoscopy can play a significant role in the care of the patient requiring accurate intra-abdominal staging. The staging procedure is conducted in a fashion identical to the open procedure, including multiple liver biopsies, a splenectomy, and multiple lymph node biopsies. Patients with non-Hodgkin's lymphoma almost never require staging, and laparoscopy may play a role in obtaining tissue for diagnosis in a small fraction of patients. Patients with Hodgkin's disease who have diffuse disease (stages III and IV) never need staging because they will all receive chemotherapy. Likewise, patients with limited disease (stage I) are usually treated with radiation therapy alone. Some patients with stage II disease will require surgical staging, which should be performed laparoscopically. The laparoscopic approach to this procedure may afford benefits to the patient including decreased hospitalization, morbidity, and reduced delays in obtaining definitive treatment.