Laparotomy for the staging of Hodgkin's disease in children.

Abstract

Abstract A review of the technique and early results of laparotomy for staging in 20 children with Hodgkin's disease, including 18 without prior therapy, is presented. Laparotomy altered the clinical stage, either “upward” or “down-ward”, in one-half of the patients. This stage change resulted in major modifications in therapy. No patients have developed abdominal Hodgkin's disease subsequent to a negative (complete) staging laparotomy. The presence of Hodgkin's disease in spleen or lymph nodes at laparotomy is frequently impossible for the surgeon to recognize. Because of this, the routine biopsy of six abdominal nodal groups is recommended, regardless of gross appearance, in addition to splenectomy, multiple liver biopsies, and marrow biopsy. Lymphangiography has been of limited value in staging, particularly in smaller children. The unique disadvantages of radiotherapy and the unknown long-range effects of chemotherapy in the growing child make the laparotomy of greater importance in the staging of Hodgkin's disease in childhood than in the adult.