Radical retroperitoneal surgery: a 25-year experience

Arterial embolus as a complication of staging laparotomy

Staging laparotomy is widely utilized in the management of selected patients with Hodgkin disease. The local trauma produced by extensive en bloc periaortic node removal for detection of subdiaphragmatic disease may predispose the patient to arterial thromboembolic events. This procedure seems undesirable and unnecessary especially in patients known to have lymphocyte-depleted and mixed-cellularity-type disease or in those found to have splenic involvement by intraoperative sectioning. These patients will often have microscopic tumor in their random needle and wedge liver biopsies taken at surgery; extensive periaortic tissue sampling is therefore unnecessary. A further concern is that such patients are likely to receive postoperative steroid chemotherapy, which has been associated with a hypercoagulative state.