ASSESSMENT OF LAPAROTOMY IN MANAGEMENT OF PATIENTS WITH HODGKINS-DISEASE

Abstract

Planned laparotomy and splenectomy was performed on 60 patients with clinical Stage I, II or III Hodgkin''s disease. Of the 60 patients, 24 (40%) changed stage and 18 patients had their treatment altered as a consequence of the procedure. Of patients without a palpably enlarged spleen, 43% had unsuspected disease when the organ was examined pathologically, although a false positive spleen was uncommon. Of 55 patients, 8 (14.5%) had intra-abdominal disease which was not detected by lymphangiography. Intra-abdominal disease occurred with all histological sub-types and was found in 2 patients who had clinical Stage I disease and lymphocyte predominance in their node histology. Sarcoid-like granulomata were found in 10 patients, 7 in the spleen, 1 in the liver and spleen, 1 in the skin and 1 in the original node biopsy. In the majority of patients, granulomata were associated with nodular sclerosing or mixed cellular histology. In all 10 patients, the Hodgkin''s disease was suppressed by appropriate chemotherapy and disease did not recur. No patient showed any clinical evidence of sarcoidosis and the Kveim test done in 3 patients was negative. Staging laparotomy was recommended for all adult patients with Hodgkin''s disease which does not show obvious generalized spread beyond lymph nodes.