PERSPECTIVE Is Staging Laparotomy Routinely Indicated in Hodgkin's Disease?

Staging laparotomy facilitates the radiotherapeutic management of patients with Hodgkin's disease when and only when the treatment approach is modified by the surgical findings. For disease clinically limited to lymph nodes above the diaphragm, as is commonly the initial presentation, surgical exploration of the abdomen rarely contributes to treatment decision-making and is not routinely justified. This conclusion is based on the observations that [1] the surgical findings have not yet been shown adequately reliable to determine the need for prophylactic abdominal irradiation; [2] unsuspected disease in sites outside the standard prophylactic treatment fields (for example, liver or lymph nodes in the porta hepatis or mesentery) is extremely uncommon; and [3] with proper field localization, irradiation of nonenlarged spleens is an effective and safe alternative to splenectomy. For patients presenting with clinical evidence of disease in the upper abdomen, exploratory laparotomy is routinely indicated. A positive lymphogram or splenomegaly, or both, implies a substantial risk of unrecognized disease in either the liver or atypically located lymph nodes. Identification of the latter alters the therapeutic approach with sufficient frequency in these selected cases to justify routine laparotomy, unless medically contraindicated. ENTHUSIASM for the radical treatment of Hodgkin's disease with radiation therapy has been generated by the recognition of the radiocurability of many patients (1). Coincidentally, there has been increasing aware-ness that patients who fail to remain continuousl