Staging laparotomy in Hodgkin's disease: Further evidence in support of its clinical utility

Abstract

Records of 99 consecutive previously untreated patients with Hodgkin's disease subjected to laparotomy at our institution were reviewed in order to assess the frequency with which inadequate or inappropriate therapy might have been administered on the basis of clinical staging alone. Of the 86 patients judged to be candidates for aggressive radiation therapy prior to laparotomy (clinical stage less than IIIB) unsuspected disease was found in the porta hepatis lateral to the margin of the usual para-aortic radiation field in 4, and occult liver involvement in an additional 2. On the other hand, 2 patients with clinically suspected hepatic involvement were found to be free of parenchymal disease and therefore candidates for aggressive radiotherapy. Of particular interest was the discovery of occult abdominal disease outside conventional extended field radiation ports in 3 patients with clinical stage IIA disease. It was not possible to reliably exclude the presence of occult disease outside standard abdominal radiation ports by previously published guidelines outlining indications for staging laparotomy.