Practical approach to laparotomy for staging in the management of lymphomas

This study was designed to delineate the role of laparotomy for staging in the management of lymphomas and to determine the accuracy of nonsurgical staging procedures. Fifty-four untreated patients with diagnoses of Hodgkin's disease or non-Hodgkin's lymphoma had extensive physical, laboratory, roentgenologic, scintigraphic, nonsurgical and surgical staging evaluation. Forty-five out of 54 patients had clinical Stage I and II disease; clinical Stage IV patients were excluded. One out of eight enlarged spleens, 12 out of 46 normal spleens, none of four enlarged livers and four out of 50 normal livers were positive at laparotomy. None of the preoperative needle biopsies of the liver and iliac crest was positive for lymphoma. The pathologic stage was advanced in six out of 25 of clinical Stage I, six out of 20 Stage II and two out of nine of Stage III. 67Ga scanning and lymphography were accurate in 16 out of 30 and 24 out of 45 patients, respectively. There was no mortality, but morbidity was limited to atelectasis, thrombophlebitis and subphrenic abscess in three patients, respectively. Only when treatment regimen is stage-dependent and only if nonsurgical staging procedures have reliably failed to rule out disseminated disease, then laparotomy for staging indicated in localized lymphomas. Laparotomy for staging should not be done when the treatment plan is not altered by staging data or when there is a medical contraindication or when evidence of disseminated disease has been reliably and consistently obtained by nonsurgical methods as needle biopsies of the liver and bone, lymphography, scintigraphic studies and laparoscopy.