An assessment of laparotomy in the management of patients with Hodgkin's disease.

Planned laparotomy and splenectomy has been a safe investigation for sixty patients with clinical Stage I, II or III Hodgkin's disease. Twenty-four of the 60 patients (40%) changed stage and 18 patients had their treatment altered as a consequence of the procedure. Forty-three per cent of patients without a palpably enlarged spleen had unsuspected disease when the organ was examined pathologically, although a false positive spleen was uncommon. Eight of 55 patients (14.5%) had intra-abdominal disease which was not detected by lymphangiography. Intra-abdominal disease occurred with all histological sub-types and was found in two patients who had clinical Stage I disease and lymphocyte predominance in their node histology. Sarcoid-like granulomata were found in ten patients, seven in the spleen, one in the liver and spleen, one in the skin and one in the original node biopsy. In the majority of patients, granulomata were associated with nodular sclerosing or mixed cellular histology. In all ten patients the Hodgkin's disease was suppressed by appropriate chemotherapy and disease has not recurred. No patient has shown any clinical evidence of sarcoidosis and the Kveim test done in three patients was negative. Our experience encourages us to recommend staging laparotomy for all adult patients with Hodgkin's disease which does not show obvious generalized spread beyond lymph nodes.