Evaluation of the surgical aspects of staging laparotomy for Hodgkin's disease in children.

Experience with 72 children in which the type of staging laparotomy recommended by the Intergroup Hodgkin's Disease in Childhood Study (IHDCS) was employed (1967-1981) is reviewed. Laparotomy altered the stage in 35% of these patients including advance in stage (I-II to III-IV) in 24 patients, and reduction in stage (III to II) in one patient. In adults, Stage III disease is divided into III1 and III2 on the basis of the presence or absence of lower abdominal node involvement; and prognosis is significantly better in III1. Nine patients from two additional institutions were included in a special study of Stage III disease. This included 22 children in III1 and 11 children in III2. Although the children with Stage B (systemic symptoms) disease were concentrated in III2, none of the measured difference between these two groups were significant. No fatal postsplenectomy sepsis has been noted since the use of pneumococcal vaccine and prophylactic penicillin became standard.