Staging Laparotomy in the Management of Hodgkin's Disease: Is it Still Necessary?

Multani, Pratik S.; Grossbard, Michael L.

doi:10.1634/theoncologist.1-1-41

Cited by 9 publications

(4 citation statements)

References 139 publications

(268 reference statements)

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“…This strategy accepts the morbidity of salvage chemotherapy and ignores the observation that the stage of HD will be changed by laparotomy in 30% of patients. 2 A review of staging laparotomy by Multani and Grossbard 11 showed a mortality of 0.3% to 1%, major morbidity of 3% to 18%, and minor morbidity of 6% to 19%. Morbidity-related delays of subsequent treatment occurred in 5% to 10% of patients.…”

Section: Commentmentioning

confidence: 99%

Comparison of Laparoscopic and Open Staging in Hodgkin Disease

Baccarani¹

1998

Arch Surg

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Background: Staging laparotomy provides useful information for management of Hodgkin disease but has fallen into disfavor because procedure-related morbidity exceeds that of new chemotherapeutic regimens. Objective: To determine the feasibility, effectiveness, and safety of laparoscopic staging for Hodgkin disease compared with those of open staging. Patients: Fifty-five patients with Hodgkin disease of cell types including nodular sclerosis in 43 (78%), mixed cellularity in 9 (16%), and lymphocyte predominance in 3 (5%). Study Design: Concurrent evaluation of laparoscopic staging (n=15) and retrospective review of open staging (n=40). Interventions: Laparoscopic and open techniques of surgical staging for Hodgkin disease, including splenectomy, liver biopsies, and lymph node sampling. Main Outcome Measures: Operative time, duration of postoperative ileus and of postoperative hospitalization, morbidity, number of lymph nodes retrieved, alteration in pathologic stage, recurrence, and survival. Results: For laparoscopic staging vs open staging groups, mean operative time was 202 vs 144 minutes (P=.001); mean postoperative ileus was 1.9 vs 3.2 days (PϽ.001); mean postoperative hospitalization was 4.4 vs 6.7 days (PϽ.001); complications occurred in 3 patients (20%) vs 11 patients (28%) (P=.57); and mean number of lymph nodes retrieved was 8.5 vs 4.6 (P=.05). In the laparoscopic staging group, 2 cases (13%) were upstaged and 2 cases (13%) were downstaged. In the open staging group, 6 cases (15%) were upstaged and 3 cases (7.5%) were downstaged. Follow-up data were available for all patients in the laparoscopic staging group, at a mean of 23.5 months postoperatively. All were alive, none had recurrent disease below the diaphragm, and 2 (13%) had residual mediastinal disease. Follow-up data were available for 31 patients (78%) in the open staging group at a mean of 52.5 months postoperatively. All were alive, 27 (87%) were disease free, 3 (10%) had had relapses above the diaphragm, and 1 (3%) had residual mediastinal disease. Conclusions: Compared with open staging, laparoscopic staging of Hodgkin disease is oncologically equivalent and functionally superior. These data should encourage reappraisal of the role of operative staging in the management of Hodgkin disease.

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Section: Commentmentioning

confidence: 99%

Comparison of Laparoscopic and Open Staging in Hodgkin Disease

Baccarani¹

1998

Arch Surg

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“…As the long-term complications caused by treatments, radiation therapy has been reported to increase the potential of developing lung and breast cancers, and long-term complications due to a splenectomy (21,22) and chemotherapy the incidence of cardiac and pulmonary diseases, and sterility (23).…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcome of Limited Stage Hodgkin's Disease

et al. 2005

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“…In selected situations, as in bulky mediastinal disease, both chemotherapy and radiotherapy are usually recommended [3][4][5][6][7]. A recent review in this journal made the case for avoiding staging laparotomy for supradiaphragmatic, nonbulky clinical stage I or II patients [8]. We believe that an alternative point of view also deserves consideration.…”

mentioning

confidence: 99%

“…The utility of staging for Hodgkin's disease has been debated over the past 30 years, and it is again the issue of debate in the recent scholarly publication by Multani and Grossbard [8]. The necessity of staging laparotomy is again questioned.…”

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confidence: 99%

To Lap or Not to Lap

1996

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Experience at various institutions has shown staging laparotomy to be an important procedure to define a subset of patients who may be treated with radiation therapy alone. Available clinical tests without staging laparotomy understage patients in approximately one‐third of the time. Since the majority of pathologic stage III patients are probably best treated with combination chemotherapy, initial treatment with radiation therapy without staging laparotomy may be suboptimal. The patients with clinical stage I and II Hodgkin's disease who present for therapy should be treated with a regimen that maximizes the chances for cure the first time around. The group of patients which fails initial radiation therapy after clinical staging may experience toxicities of both full‐dose radiation therapy and salvage chemotherapy without survival benefit. Staging laparotomy has acceptable morbidity, and it continues to provide crucial data for effective treatment planning.

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Staging Laparotomy in the Management of Hodgkin's Disease: Is it Still Necessary?

Cited by 9 publications

References 139 publications

Comparison of Laparoscopic and Open Staging in Hodgkin Disease

Comparison of Laparoscopic and Open Staging in Hodgkin Disease

Treatment Outcome of Limited Stage Hodgkin's Disease

To Lap or Not to Lap

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