Staging laparotomy with splenectomy in Stage I and II Hodgkin’s disease. No therapeutic benefit

During the last two decades, staging laparotomy with splenectomy was adopted by many centers as a routine procedure in the work-up of patients with early stage Hodgkin’s disease (HD). This staging procedure determines accurately subdiaphragmatic involvement with HD, thus reduces the extent of radiation therapy (RT). However, despite negative findings at laparotomy, RT continues to be delivered to the upper paraaortic nodes and splenic bed in many centers [1, 2, 3]. Since dissemination of HD in the abdomen appears to begin in the spleen and/or in the lymph nodes of the upper abdomen [4], this routine extention of the RT port to the upper abdomen makes it difficult to assess the role of staging with laparotomy procedure in the prevention of abdominal relapse.