T H E VALUE OF STAGING LAPAROTOMY IN NON-HODGKIN’S LYMPHOMAS

Laparotomy with splenectomy and multiple tissue biopsies was performed in 106 adult patients with non-Hodgkin’s lymphoma (histiocytic-76, lymphocytic25, and mixed type-5). The histologic pattern at initial biopsy showed nodular lymphoma in 33% and diffuse lymphoma in 67%. Diffuse histiocytic was the most frequently observed histologic type in this series (54%). Before laparotomy, 92% of patients had primary lymphatic and 8% primary extralymphatic involvement. Waldeyer’s ring involvement accounted for 27% of all patients. Systemic symptoms were present in 7%. Clinical stage (Ann Arbor Classification as proposed for Hodgkin’s disease) was as follows: I--29%, 11-32%, 11,2%, III-24%, III,-8%, and IV-5%. After staging laparotomy these figures were 2595, 2996, 196, 20,% S%, and 17%, respectively (down stage 23%, up stage 4%). Spleen was involved in 2396, liver in 12%, gastrointestinal tract in 5%, and bone marrow in 12%. I n 2796, lesions were occult to conventional diagnostic methods. Although not sampled in all patients, splenic hilar, celiac, and mesenteric nodes were the most frequent occult sites of intra-abdominal lymphoma. With clinical methods, false negative findings for spleen involvement were 12% and for liver 11%. Spleen involvement occurred more often in nodular (29%) than in diffuse lymphoma (19%). There was no appreciable difference in the splenic infiltration among histiocytic (22%), lymphocytic (24%), and mixed (20%) types. With the exception of one case, there were no patients with hepatic involvement without concomitant splenic involvement. Lymphography yielded a 96% accuracy proving once more to be a sufficiently reliable diagnostic method. Two patients died after laparotomy because of acute peritonitis and acute pancreatic necrosis, respectively. Otherwise, the incidence and type of complications were found acceptable. Collectively, our findings indicate that staging laparotomy is a useful procedure in non-Hodgkin’s lymphomas to identify occult lesions before planning treatment and to gain more information on the natural history of these diseases.

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