Staging laparotomy in Hodgkin's disease: a critical appraisal of its value

Although staging laparotomy changes the stage of one third of patients with Hodgkin's disease, this change in stage does not establish that routine staging laparotomy is of clinical value. The value of laparotomy depends on the results of clinical decisions which are based on the information provided by laparotomy. Increased accuracy in staging may improve clinical results by eliminating undertreatment, with an increased risk of relapse, or overtreatment with an increased risk of morbidity--including second malignancies. In some clinical settings information provided by laparotomy may be clinically irrelevant. Since clinical studies have not established the optimal therapy for every stage of Hodgkin's disease, rigid guidelines for performing staging laporotomies cannot be established. However, staging laparotomy should be done only after consideration of how the information provided by laparotomy will affect clinical decisions. Recent evidence that the extent of abdominal nodal involvement has major prognostic implications may play a role in this decision-making process.