Staging laparotomy in early Hodgkin's disease: a surgical view

Fifty consecutive patients with early Hodgkin's disease underwent staging laparotomy. There were no deaths and most complications were minor. As a consequence, 17 (34%) patients were upstaged from clinical stage I or II to pathological stage III or IV. Subdiaphragmatic disease was found in five out of 22 patients with nodular sclerosing, seven out of ten with lymphocyte predominant and four out of 13 patients with mixed cellularity histological type. The age, sex, preoperative clinical stage and mediastinal involvement did not correlate with the presence of intra-abdominal disease. Among 15 patients with a normal preoperative computed tomography (CT) scan, nine had intra-abdominal disease at laparotomy and all three patients with suggested subdiaphragmatic involvement by the CT scan examination were clear. The surgeon's ability to diagnose early involvement at laparotomy was also limited. There seems to be a continued need for staging laparotomy to ensure adequate treatment of one-third of patients with early Hodgkin's disease.