[Laparosplenectomy in Hodgkin's disease]

Assessment of a series of 102 cases of laparotomy with splenectomy in the diagnosis of Hodgkin's disease is undertaken in an explantation of the indications for its employment in relation to the progress of the disease and its histological type. An account is also offered of the salient features of each surgical stage, and the findings made during surgery by comparison with those obtained in other ways, i.e. preoperative appraisal based mainly on lymphography, hepatosplenic scintiscans, and functional exploration of the liver. Analysis of the results in the light of the histological data and their clinical and pathological relations enables four conclusions to be drawn: 1) isotopic investigations and functional tests carried out prior to surgery are insufficient, or at any rate poorly reliable; 2) absence of gross criteria for the sufficiently precise determination of splenic Hodgkin sites intraoperatively; 3) discrepancy between the lymph node histology and the lymphographic picture; 4) high incidence of primary subdiaphragmatic splenic involvement. The opinion is expressed that laparosplenectomy is a sound procedure for establishing the actual extent of Hodgkin's disease, and hence permitting more logical and more accurate further management. Emphasis is also laid on the fact that removal of the spleen may protect the liver from the possible spread of the disease via the porta, and make irradiation of the left hypochondriac region with its attendant dangers unnecessary.