An assessment of staging laparotomy in Hodgkin's disease

Serious morbidity from an elective Hodgkin's disease staging laparotomy was low in this group of 65 patients. Patients with mediastinal involvement alone and patients having histologic findings of nodular sclerosis with unilateral neck disease with or without mediastinal involvement appear to have a low risk for disease discoverable by lararotomy. In these situations, we believe that the staging laparotomy may be optional provided that the apleen and paraaortic areas are irradiated. The laparotomy does enable the radiotherapist to reduce the volume of normal tissue treated, and we think we are safer in omitting pelvic irradiation in the patient with early stage, asymptomatic nodular sclerosis if the negative clinical evaluation of the abdomen is confirmed surgically. The incidence of major treatment change because of the findings at laparotomy was low, two of 30, in our patients with a normal lymphangiogram. There was a high likelihood, nine of 30, of major change of treatment from the staging laparotomy in patients with an abnormal lymphangiogram.