Laparotomy and splenectomy in Hodgkin's disease—diagnostic, preventive and therapeutic

Abstract

Thirty primarily unselected but a mixed population of ‘virgin’ and treated patients with a diagnosis of Hodgkin's Disease were subjected to diagnostic laparotomy, splenectomy, liver biopsy, and para‐aortic lymph node biopsy as part of their evaluation for the purpose of staging the disease. The post‐operative pathologic findings were correlated with the preoperative clinical evaluation. Preoperative evaluation of abdominal lymph nodes, spleen, and liver was inaccurate in 3/25 (12%), 9/30 (30%), and 5/30 (17%) patients, respectively, with the result that there was a change in the post‐operative staging in eleven (37%) patients. No instance of liver involvement by Hodgkin's Disease was noted without concomitant splenic involvement. Also, there was no instance of splenic involvement without a concomitant para‐aortic lymph node involvement. These findings suggest a possible spread of the disease to the spleen via the abdominal lymph nodes and to the liver via the spleen. It is concluded that laparotomy with splenectomy is a valuable procedure for diagnostic delineation of intra‐abdominal disease but in addition has therapeutic and preventive implications.