COMPARISON OF LAPAROSCOPIC AND OPEN STAGING IN HODGKIN-DISEASE

Background: Staging laparotomy provides useful information for managem ent of Hodgkin disease but has fallen into disfavor because procedure- related morbidity exceeds that of new chemotherapeutic regimens. Objec tive: To determine the feasibility, effectiveness, and safety of lapar oscopic staging for Hodgkin disease compared with those of open stagin g. Patients: Fifty-five patients with Hodgkin disease of cell types in cluding nodular sclerosis in 43 (78%), mixed cellularity in 9 (16%), a nd lymphocyte predominance in 3 (5%). Study Design: Concurrent evaluat ion of laparoscopic staging (n=15) and retrospective review of open st aging (n=40). Interventions: Laparoscopic and open techniques of surgi cal staging for Hodgkin disease, including splenectomy, liver biopsies , and lymph node sampling. Main Outcome Measures: Operative time, dura tion of postoperative ileus and of postoperative hospitalization, morb idity, number of lymph nodes retrieved, alteration in pathologic stage , recurrence, and survival. Results: For laparoscopic staging vs open staging groups, mean operative time was 202 vs 144 minutes (P=.001); m ean postoperative ileus was 1.9 vs 3.2 days (P<.001); mean postoperati ve hospitalization was 4.4 vs 6.7 days (P<.001); complications occurre d in 3 patients (20%) vs 11 patients (28%) (P=.57); and mean number of lymph nodes retrieved was 8.5 vs 4.6 (P=.05). In the laparoscopic sta ging group, 2 cases (13%) were upstaged and 2 cases (13%) were downsta ged. In the open staging group, 6 cases (15%) were upstaged and 3 case s (7.5%) were downstaged. Follow-up data were available for all patien ts in the laparoscopic staging group, at a mean of 23.5 months postope ratively. All were alive, none had recurrent disease below the diaphra gm, and 2 (13%) had residual mediastinal disease. Follow-up data were available for 31 patients (78%) in the open staging group at a mean of 52.5 months postoperatively. All were alive, 27 (87%) were disease fr ee, 3 (10%) had had relapses above the diaphragm, and 1 (3%) had resid ual mediastinal disease. Conclusions: Compared with open staging, lapa roscopic staging of Hodgkin disease is oncologically equivalent and fu nctionally superior. These data should encourage reappraisal of the ro le of operative staging in the management of Hodgkin disease.