Surgical exploration of the abdominal lymphatic system in patients with malignancies

In the management of selected patient with malignant diseases, laparotomy can be useful for determining the anatomic extent of disease in order to individualize appropriate intensive treatment. The decision to subject a patient to a staging laparotomy requires joint decisions by surgeons, radiation therapists, chemotherapists, and diagnostic radiologists, after a thorough preoperative abdominal evaluation has been made. The lymphangiogram is especially important for directing the surgeon to a single node of concern. Special efforts must be made to insure that the specific node in question is biopsied. The justification of such a surgical procedure assumes that definitive decisions in management of such patients will result in an improved prognosis. While this appears to be the case with Hodgkin's disease and lymphomas, studies are underway to prove this assumption in other neoplasms. For most patients, staging laparotomy presently represents an investigational procedure of value only in selected patients. The critical problem is how these patients can be identified.