Staging laparotomy in the management of hodgkin's disease: Is it still necessary?

Approximately 3,500 cases of stage I and II Hodgkin's disease are diagnosed each year in the United States. Traditionally, those patients who are considered candidates for primary radiation therapy undergo staging laparotomy (pathologic staging) to rule out definitively the presence of occult subdiaphragmatic disease. An appreciation of the risks of laparotomy and a recognition of the effectiveness of salvage chemotherapy in patients who fail primary radiation therapy have permitted the increased use of clinical staging as the basis for treatment of these patients. This article summarizes the literature regarding the need for staging laparotomy in early stage Hodgkin's disease and suggests alternative approaches to the management of these patients based on clinical criteria and prognostic factors.