LONG-TERM COMPLICATIONS OF LAPAROTOMY IN HODGKINS-DISEASE

Objective The authors determined the incidence of complications in 133 patients who had undergone staging laparotomy with splenectomy before treatment for Hodgkin's disease (stages I-IV). Methods and Materials Medical records were reviewed, and the patients or their relatives wer e interviewed. Median follow-up after laparotomy was 15.7 years (range = 2.5-28 years). Results Ten episodes of overwhelming postsplenectomy infection (OPSI) were documented in nine patients (6.8%), None of 25 patients who received pneumococcal vaccine before splenectomy develope d OPSI. Patients with advanced (stages III-IV) or recurrent Hodgkin's disease were at higher risk of OPSI than those with early disease, and those who received combined modality oncologic therapy were at greate r risk than those receiving less intensive treatment. Surgical complic ations included small bowel obstruction in 13 patients (9.8%), necessi tating repeat laparotomy in 9 patients (6.8%), atelectasis in 17 patie nts, abscess in 3 patients, and 1 wound dehiscence. No deaths occurred as a result of surgical complications. Causes of death in the 29 pati ents who died included Hodgkin's disease (12 patients), acute treatmen t-related morbidity (1 patient), leukemia (5 patients), bone marrow fa ilure (3 patients), solid malignancy (2 patients), intercurrent diseas e (4 patients), unknown causes (1 patient), and OPSI (1 patient). Conc lusion With presplenectomy pneumococcal vaccination and modern surgica l techniques, the long-term risks of laparotomy with splenectomy are a cceptable if knowledge of the pathologic extent of abdominal Hodgkin's disease would alter treatment regimens.