Posttreatment laparotomy as a guide to management in patients with Hodgkin's disease

Staging laparotomy and splenectomy were performed on 46 adult patients after combination chemotherapy for advanced Hodgkin's disease (HD). There was no preoperative evidence of intra-abdominal disease in 32 patients, 27 of whom were in complete clinical remission, while five had only residual mediastinal abnormalities. In the remaining 14 patients, there was clinical suspicion of active HD. Histologically abnormal tissue was obtained from 19 of 46 (41%) operations. Active abdominal HD was detected in six of 46 patients (13%) or in six of 19 patients having previous evidence of intra-abdominal disease (31%). The spleen was involved in all patients, and in two of these patients there was evidence of both active and ablated disease. Pathologic evidence of ablated HD was detected in 13 patients. The prediction of active intra-abdominal HD, by lymphography or by computerized tomographic scanning, following mustine, vinblastine, procarbazine, and prednisolone therapy, was frequently inaccurate. There was no operative mortality. Morbidity was similar to that of pretreatment laparotomy. At a median followup of 26.5 months (range 5-59), 39 of 40 patients with no evidence of active abdominal HD remain in continuous remission. The contribution of posttreatment laparotomy toward the management of patients with HD is discussed.