Indications for staging laparotomy and partial splenectomy

Abstract

The value of staging laparotomy with splenectomy for the staging of Hodg-kin’s disease was first reported in 1969 by Glatstein et al. [1]. Several reports have demonstrated changes in the clinical stage (according to the Ann Arbor staging classification) in 15% to ~50% of the children with Hodgkin’s disease who underwent a staging laparotomy with splenectomy [2–9]. A staging laparotomy is a safe surgical procedure with a low acute morbidity and a mortality rate of <1% [10]. Late complications are intestinal obstruction (4%) and overwhelming infections (10%–20%) [10–14]. The risk of postsplenectomy sepsis is ~10% and particularly high in children with Hodgkin’s disease treated with combined-modality therapies of radiotherapy and chemotherapy, due to the disturbance of the immune system [12]. The mortality of this postsplenectomy sepsis is high and can reach up to 50% [12, 15]. Pneumococcal vaccine and routine prophylactic antibiotic therapy with penicillin or erythromycin has reduced the incidence of postsplenectomy infections in these children [16, 17]. To decrease the hazard of overwhelming postsplenectomy infections, partial splenectomy was introduced in the staging procedure for Hodgkin’s disease [13, 18]. Other centers avoid splenectomies for Hodgkin’s disease, especially in the younger children [19].