Is staging laparotomy necessary in Hodgkin's disease? An analysis of 100 operations

A series of 100 patients with Hodgkin's disease were submitted to staging laparotomy, without mortality and with negligible morbidity. Thirty-one patients were restaged: 23 had occult intra-abdominal disease and 8 false-positive lymphangiograms. Standardized treatment programmes were tested against our clinical and pathological data to determine whether staging laparotomy would alter therapeutic decisions. Programmes based on clinical staging and employing radical radiotherapy would have encompassed all disease without recourse to laparotomy. In contrast, a more conservative programme which employed mantle field irradiation for clinically localized cervical disease, without laparotomy, would have missed disease in 12% of cases. Patients with supradiaphragmatic nodal Hodgkin's disease should either have prophylactic abdominal irradiation (without laparotomy) or more limited radiotherapy determined by laparotomy (without prophylactic irradiation).