Laparoscopy for the definitive diagnosis of intra-abdominal lymphoma

To assess the efficacy of laparoscopy in the diagnosis of intra-abdominal lymphoma.

The medical records of patients with suspected primary or recurrent lymphoma who underwent laparoscopy between March 1991 and March 2003 were reviewed. Demographic, clinical, operative, and pathologic data were collected. The feasibility, safety, and effectiveness of the laparoscopic procedure were assessed.

Laparoscopic biopsy was attempted in 94 patients. In 78 patients (83%), the procedure was completed laparoscopically. Conversion to laparotomy was undertaken in 16 patients (17%), most commonly because of inadequate exposure, insufficient tissue, or postoperative adhesions. Among the 69 cases of lymphoma, 55 (80%) were diagnosed via laparoscopy only, 9 (13%) via laparotomy, and 5 (7%) with later procedures. Of the remaining 25 patients, 7 had nonlymphoma disease (4 occult carcinomas, 1 multiple myeloma, 1 epithelioid leiomyosarcoma, and 1 neuroblastoma), and 18 had benign lymphadenopathy (no evidence of lymphoma with a mean follow-up of 53 months). The laparoscopic procedure resulted in false-negative results in 6 patients (6%). The mean hospital stay for patients having a laparotomy was 6 days (range, 3-10 days); the remaining patients were all outpatients. The only Intraoperative laparoscopic complication was hemorrhage that required laparotomy. This event occurred in a patient with a previously undiagnosed neuroblastoma.

Laparoscopic lymph node biopsy safely provides adequate tissue for full histological evaluation on an outpatient basis in most patients with intra-abdominal lymphoma.