Laparotomy in the re-evaluation of patients with advanced Hodgkin's disease

Twelve patients with advanced nodular sclerosis Hodgkin's disease were extensively reassessed following the completion of planned chemotherapy. The evaluation culminated in an exploratory laparotomy. Eight patients with no evidence of abdominal involvement on noninvasive tests also had no Hodgkin's disease found during laparotomy. Four patients had intra-abdominal Hodgkin's disease suspected prior to laparotomy based on the results of the noninvasive procedures. At laparotomy, benign abnormalities were present in three patients; only one had residual Hodgkin's disease. No patient with a negative laparotomy has developed recurrent abdominal Hodgkin's disease, but two patients developed supradiaphragmatic recurrences. The patient with persistent Hodgkin's disease had his treatment regimen successfully altered. These data suggest that patients with negative preoperative findings do not benefit further from a laparotomy. However, in selected patients with suspicious intra-abdominal findings, the results of laparotomy may alter future management.