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].
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References
Glatstein E, Guernsey JM, Rosenberg SA, Kaplan H: The value of laparotomy and splenectomy in the staging of Hodgkin’s disease. Cancer 24:709–718, 1969.
Carbone PP, Kaplan HS, Musshoff K, et al.: Report of the Committee on Hodgkin’s Disease Staging. Cancer Res 31:1860–1861, 1971.
Filler RM, Jaffe N, Cassady JR, Traggis DG, Vawter GF: Experience with clinical and operative staging of Hodgkin’s disease in children. J Pediatr Surg 10:321–328, 1975.
Lanzkowsky P, Shende A, Karayalcin G, Azal I: Staging laparotomy and splenectomy: treatment and complications of Hodgkin’s disease in children. Am J Hematol 1:393–406, 1976.
Donaldson SS, Glatstein E, Rosenberg SA, et al.: Pediatric Hodgkin’s disease II. Cancer 37:2436–2447, 1976.
Bell MJ, Land VJ, Ternberg JL: Staging laparotomy for Hodgkin’s disease in children. Am J Surg 113:582–583, 1977.
Cohen JT, Higgins GR, Powars DR, Hays DM: Staging laparotomy for Hodgkin’s disease in children. Arch Surg 112:948–951, 1977.
Dearth JC, Gilchrist GS, Burgert ED, et al.: Management of stages I to III Hodgkin’s disease in children. J Pediatr 96:829–836, 1980.
Jenkin RD, Berry MP: Hodgkin’s disease in children. Semin Oncol 8:202–211, 1980.
Green DM, Ghoorah J, Douglass HO, et al.: Staging laparotomy with splenectomy in children and adolescents with Hodgkin’s disease. Cancer Treat Rev 10:23–38, 1983.
Donaldson SS, Moore MR, Rosenberg SA, et al.: Characterization of post-splenectomy bacteremia among patients with and without lymphoma. N Engl J Med 287:69–71, 1972.
Chilcote RR, Baeher RH, Hammond D: Septicemia and meningitis in children splenecto-mized for Hodgkin’s disease. N Engl J Med 295:798–800, 1976.
Boles ET, Haase GM, Hamoudi AB: Partial splenectomy in staging laparotomy for Hodgkin’s disease: an alternative approach. J Pediatr Surg 13:581–586, 1978.
Dearth JC, Gilchrist GS, Telander RL, O’Conell MJ, Weiland LH: Partial splenectomy for staging Hodgkin’s disease: risk of false negative results. N Eng J Med 299:345–346, 1978.
Singer AB: Postsplenectomy sepsis. Perspect Pediatr Pathol 1:285–311, 1973.
Mauch PM, Weinstein H, Botnick L, et al.: An evaluation of long-term survival and treatment complications in children with Hodgkin’s disease. Cancer 51:925–932, 1983.
Donaldson SS, Glatstein E, Vosti KL: Bacterial infections in children and adolescents. Cancer 41:1949–1958, 1978.
Holschneider AM, Löhrs U, Haas R, Dickerhoff R, Gollmitzer W: Selective hemi-splenectomy for Hodgkin’s disease. In: Wurning P, Klos I (eds) Progress in pediatric surgery, vol 18. Berlin: Springer, 1985, pp 162–168.
Eraklis AJ, Levy SV, Diamond LK, et al.: Hazard of overwhelming infection after splenectomy in childhood. N Eng J Med 276:1225–1229, 1967.
Schreiber DP, Jacobs C, Rosenberg SA, et al.: The potential benefits of therapeutic splenectomy for patients with Hodgkin’s disease and non-Hodgkin’s lymphomas. Int J Radiat Oncol Biol Phys 11:31–36, 1985.
Poppema S, Lennert K: Hodgkin’s disease in childhood: histopathologic classification in relation to age and sex. Cancer 45:1443–1447, 1980.
Govrin-Yehudain J, Bar-Maor JA: Partial splenectomy in Gaucher’s disease. Isr J Med Sei 16:665, 1986.
Pringle KC, Hays DM: Current management and controversies: a surgeons view. This volume, ch. 8.
Butain WL, Lynn HB: Splenorrhaphy: changing concepts for the traumatized spleen. Surgery 86:748–760, 1979.
Schier KS, Scott-Conner C, Jones CW, Wroczynski AF: Methods of splenic preservation and their effect on clearance of pneumococcal bacteremia. Ann Surg 202:595–599, 1985.
Pringle KC, Rowley D, Burrington JD: Immunologic response in splenectomized and partially splenectomized rats. J Pediatr Surg 15:531–536, 1980.
Bradshaw PH, Thomas CG: Regeneration of splenic remnants after partial splenectomy in rats. J Surg Res 32:176–181, 1982.
Goldthorn JF, Schwartz AD, Swift AJ, Winkelstein JA: Protective effect of residual splenic tissue after subtotal splenectomy. J Pediatr Surg 13:587–590, 1978.
Okinaga K, Giebink SG, Rich RH, Baes ITJ, Krishnanaik D, Leonard AS: The effect of partial splenectomy on experimental pneumococcal bacteremia in an animal model. J Pediatr Surg 16:717–724, 1981.
Coleman CN, McDougall R, Morris OD, Ager P, Bush S, Kaplan HS: Functional hypo-splenia after splenic irradiation for Hodgkin’s disease. Ann Intern Med 96:44–47, 1982.
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© 1989 Kluwer Academic Publishers, Boston
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Hoekstra, H.J., Kamps, W.A. (1989). Indications for staging laparotomy and partial splenectomy. In: Kamps, W.A., Humphrey, G.B., Poppema, S. (eds) Hodgkin’s Disease in Children. Cancer Treatment and Research, vol 41. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1739-5_9
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