Laparoscopic evaluation of lymphoma

Surgeons are involved in the diagnosis and staging of patients with lymphoma. Treatment requires accurate information about histologic classification and the extent of disease. While most patients with non-Hodgkin's lymphoma are treated with systemic chemotherapy, the exact stage of disease in patients with Hodgkin's lymphoma may determine the therapy to be used. The use of minimally invasive surgery in surgical staging of patients with Hodgkin's disease has the potential to decrease the morbidity and mortality of the staging procedure in these patients. All of the components of a staging procedure (liver biopsies, splenectomy, lymph node biopsies, and oophoropexy) can be performed laparoscopically. The procedure is performed with the patient in the supine position. After obtaining several liver biopsies, the splenectomy is completed. Lymph nodes are then sampled from the celiac, portal, iliac, and peri-aortic regions. Lymph nodes identified as abnormal on pre-operative imaging studies are identified and excised. While each of these procedures is technically challenging, the laparoscopic conduct of this diagnostic procedure may afford patients decreased post-operative morbidity and mortality.