Stein R S
South Med J. 1978 Dec;71(12):1553-8. doi: 10.1097/00007611-197812000-00030.
Although staging laparotomy changes the stage of one third of patients with Hodgkin's disease, this change in stage does not establish that routine staging laparotomy is of clinical value. The value of laparotomy depends on the results of clinical decisions which are based on the information provided by laparotomy. Increased accuracy in staging may improve clinical results by eliminating undertreatment, with an increased risk of relapse, or overtreatment with an increased risk of morbidity--including second malignancies. In some clinical settings information provided by laparotomy may be clinically irrelevant. Since clinical studies have not established the optimal therapy for every stage of Hodgkin's disease, rigid guidelines for performing staging laporotomies cannot be established. However, staging laparotomy should be done only after consideration of how the information provided by laparotomy will affect clinical decisions. Recent evidence that the extent of abdominal nodal involvement has major prognostic implications may play a role in this decision-making process.
尽管分期剖腹术可改变三分之一霍奇金病患者的分期，但分期的这种改变并不能证明常规分期剖腹术具有临床价值。剖腹术的价值取决于基于剖腹术所提供信息而做出的临床决策结果。分期准确性的提高可能通过避免治疗不足（从而增加复发风险）或过度治疗（从而增加包括第二原发恶性肿瘤在内的发病风险）来改善临床疗效。在某些临床情况下，剖腹术所提供的信息可能与临床无关。由于临床研究尚未确立霍奇金病各期的最佳治疗方法，因此无法制定进行分期剖腹术的严格指南。然而，仅在考虑剖腹术所提供的信息将如何影响临床决策之后，才应进行分期剖腹术。最近有证据表明腹部淋巴结受累程度具有重要的预后意义，这可能在这一决策过程中发挥作用。
