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Staging laparotomy with splenectomy for Hodgkin's disease: The Stanford experience

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Abstract

The results of 825 staging laparotomies performed by surgeons at Stanford University Hospital are presented. The clinical stage was changed as a result of laparotomy in 43.2% of cases. Preoperative lymphangiography proved accurate in 78–80% of cases. In 321 patients (38.9%) the test results for the spleen were positive, and in161 (50.2%) of these, the spleen was the only positive tissue sampled. Major complications occurred in 9.6% of cases; most were wound and upper respiratory infections. The results of laparotomy have identified a subgroup of stage NIA patients who benefit from early systemic chemotherapy. Staging laparotomy with splenectomy has proven to be a useful and safe clinical research tool and has been one of the major factors in increasing survival from Hodgkin's disease.

Résumé

Les résultats de 825 laparotomies d'évaluation du stade évolutif de la maladie de Hodgkin pratiquées à l'hôpital de la Stanford University ont été étudiés. La laparotomie permit de rectifier le stade évolutif défini par la clinique dans 43.2% des cas. La lymphangiographie préopératorie s'est montrée exacte dans 78–80% des cas. Chez 321 malades (38.9%) la rate était atteinte et chez 161 d'entre eux (50.2%) elle seule était interessée par l'affection. Des complications importantes: infection pariétale et infection respiratoire ont été observées dans 9.6% des cas. La laparotomie a permis d'identifier un groupe de malades au stade IIIA qui ont pu bénéficier d'une chimiothérapie générale. La laparotomie d'évolution du stade évolutif combinée à la splénectomie s'est montrée utile. C'est une méthode d'appréciation précise qui a permis d'améliorer la durée de la survie des malades atteints de maladie de Hodgkin.

Resumen

Se presentan los resultados de 825 laparotomía de clasificación realizadas en el Hospital de la Universidad de Stanford. La clasificación del estado clínico fué modificada como resultado de la laparotomía en el 43.2% de los casos. La linfangiografía preoperatoria dió resultados correctos en el 78–80% de los casos. En 321 pacientes (38.9%) el bazo resultó positivo, y en 50.2% (161/321) de éstos el bazo fué el único tejido positivo encontrado. Complicaciones mayores ocurrieron en 9.6% de los casos; la mayoría de ellas fueron infecciones de la herida y del tracto respiratorio superior. Los resultados de la laparotomía han identificado un subgrupo de pacientes en estado IIIA que se benefician de quimioterapia sistémica precoz. La laparotomía de clasificación con esplenectomía ha probado ser un instrumento clínico y de investigación útil y seguro y se ha convertido en uno de los principales factores de aumento de la supervivencia de pacientes con enfermedad de Hodgkin.

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Authors and Affiliations

  1. Departments of Surgery and Radiotherapy, Stanford University School of Medicine, Stanford, California, USA

    Mark A. Taylor M.D., Henry S. Kaplan M.D. & Thomas S. Nelsen M.D.

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  1. Mark A. Taylor M.D.
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  2. Henry S. Kaplan M.D.
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  3. Thomas S. Nelsen M.D.
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Taylor, M.A., Kaplan, H.S. & Nelsen, T.S. Staging laparotomy with splenectomy for Hodgkin's disease: The Stanford experience. World J. Surg. 9, 449–460 (1985). https://doi.org/10.1007/BF01655281

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