TY  - JOUR
T1  - COmparison of laparoscopic and open staging in hodgkin disease
AU  - Baccarani U, Carroll BJ, Hiatt JR, et al
Y1  - 1998/05/01
N1  - 10.1001/archsurg.133.5.517
JO  - Archives of Surgery
SP  - 517
EP  - 522
VL  - 133
IS  - 5
N2  - Background 
    Staging laparotomy provides useful information for management of Hodgkin disease but has fallen into disfavor because procedure-related morbidity exceeds that of new chemotherapeutic regimens.Objective 
    To determine the feasibility, effectiveness, and safety of laparoscopic staging for Hodgkin disease compared with those of open staging.Patients 
    Fifty-five patients with Hodgkin disease of cell types including nodular sclerosis in 43 (78%), mixed cellularity in 9 (16%), and lymphocyte predominance in 3 (5%).Study Design 
    Concurrent evaluation of laparoscopic staging (n=15) and retrospective review of open staging (n=40).Interventions 
    Laparoscopic and open techniques of surgical staging for Hodgkin disease, including splenectomy, liver biopsies, and lymph node sampling.Main Outcome Measures 
    Operative time, duration of postoperative ileus and of postoperative hospitalization, morbidity, 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); mean postoperative ileus was 1.9 vs 3.2 days (P<.001); mean postoperative hospitalization was 4.4 vs 6.7 days (P<.001); complications occurred 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 staging group, 2 cases (13%) were upstaged and 2 cases (13%) were downstaged. In the open staging group, 6 cases (15%) were upstaged and 3 cases (7.5%) were downstaged. Follow-up data were available for all patients in the laparoscopic staging group, at a mean of 23.5 months postoperatively. All were alive, none had recurrent disease below the diaphragm, 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 free, 3 (10%) had had relapses above the diaphragm, and 1 (3%) had residual mediastinal disease.Conclusions 
    Compared with open staging, laparoscopic staging of Hodgkin disease is oncologically equivalent and functionally superior. These data should encourage reappraisal of the role of operative staging in the management of Hodgkin disease.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.133.5.517
UR  - http://dx.doi.org/10.1001/archsurg.133.5.517
ER  -