Controversies in the use of diagnostic staging laparotomy and splenectomy in the management of Hodgkin's disease

Abstract

Considerable controversy exists over the routine use of diagnostic staging laparotomy and splenectomy in the workup of patients with Hodgkin's disease. With the development of effective, and perhaps less toxic chemotherapy the need for staging laparotomy has somewhat decreased. In the United States it is still common to recommend surgical staging for early stage patients when the results influence the choice of treatment. Since 20%–30% of clinically staged (CS) IA-IIA and 35% of CS IB-IIB patients with Hodgkin's disease will have occult splenic or upper abdominal nodal involvement not detected by LAG, CT, MRI, or gallium imaging, staging laparotomy allows for selection of patients either to receive limited radiation therapy alone (most PS I-II patients) or chemotherapy with or without radiation (PS III). In Europe, Canada, and South America most patients are clinically staged without a laparotomy. Patients are selected for treatment with radiation therapy alone or for chemotherapy with or without radiation on the basis of clinical prognostic factors. This article details the current arguments for and against the use of staging laparotomy.