Staging laparotomy in Hodgkin's disease: a community hospital experience

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.

Correlation of lymphangiography, computed tomography, and laparotomy in the staging of Hodgkin's disease

PURPOSE

To determine the predictive value of lymphangiography and computed tomography of the abdomen and pelvis for infradiaphragmatic involvement of Hodgkin's disease.

METHODS AND METHODS

We retrospectively reviewed the findings on 125 patients with Hodgkin's disease treated at the University of Florida who underwent lymphangiography and staging laparotomy; 33 patients also underwent computed tomography of the abdomen and pelvis. The positive predictive value and negative predictive value were calculated for both studies.

RESULTS

The positive predictive value of lymphangiography for paraaortic or pelvic disease was 35%, while the negative predictive value was 95%. The positive predictive value of computed tomography of the abdomen and pelvis for paraaortic or pelvic disease was 20%; the negative predictive value was 93%. There was no advantage in predicting paraaortic or pelvic disease when both studies were obtained as compared to either study alone. For splenic disease, the positive predictive value of computed tomography was 43%; the negative predictive value was 77%. Of the patients with a positive lymphangiography, 57% were found at laparotomy to have either no abdominal disease or upper abdominal disease only, with or without minimal splenic disease, making them reasonable candidates for radiotherapy alone. Of the patients with a negative lymphangiogram, 14% were found at laparotomy to have either lower abdominal disease or extensive splenic disease, and so were not good candidates for radiotherapy alone.

CONCLUSION

We recommend laparotomy for patients who may be candidates for radiotherapy alone or combined modality therapy with limited chemotherapy.

Staging laparotomy in Hodgkin's lymphoma: 1979 to 1988

A retrospective review of patients with Hodgkin's lymphoma undergoing staging laparotomy was done. Ninety-four patients were identified for analysis. Preoperative lymphangiography was performed in 86 patients, and computed tomography of the abdomen was performed in 53. Both proved to have an accuracy rate of 76%. Mortality and 30-day morbidity rates were 0% and 17%, respectively, when both major (8%) and minor (10%) complications were considered. Late complications (greater than 30 days) were noted in 5%. The results of the laparotomy required a change in staging in 28% of patients, with alterations in subsequent clinical management occurring in 18%. In selected patients, staging laparotomy is safe and remains a reliable means of determining the intra-abdominal extent of Hodgkin's lymphoma.