Selective Hemisplenectomy for Hodgkin’s Disease

Abstract

The staging laparotomy was introduced in the diagnosis of Hodgkin’s disease in 1969 by Glatstein as an exploratory laparotomy with a splenectomy. It allows a more exact analysis of the spread of the disease, which in children leads to a change in the classification of the stage in 15%–20% of the cases, whereby two-thirds of the patients must be classified as higher stages (Hellmann 1974; Lanzowsky et al. 1975; Filler et al. 1975; Cohen et al. 1977; Begemann and Theml 1978; Janka et al. 1978). Involvement of the spleen, which cannot be recognized with clinical methods, is mostly responsible for this. Generally, in both children and adults, the spleen is affected in approximately 30%–50% of cases. Thus, the staging laparotomy has direct influence on the manner and intensity of the therapy. Apart from that, it does not have any therapeutic value (Ihde et al. 1976; Begemann 1975; Begemann and Theml 1978). Also, the occasionally suggested bilateral oophoropexy does not seem to make much sense, as scattered X-rays cannot be avoided. The marking of a possible tumor bed with silver clips has the advantage of facilitating precise, postoperative radiotherapy, but silver clips cause artifacts in later computer tomograms and could thus make the diagnosis of a recurrence more difficult. The clips should be inserted only briefly for an intraoperative X-ray film and removed afterwards before the peritoneum is closed. It is generally regarded as useful to make a thorough diagnosis of splenic involvement so as to avoid not only prophylactic spleen radiation, which could lead to sclerosis and malfunction of the organ, but also the simultaneous radiation of the left kidney and the left lower lobe of the lung.