Place of Splenectomy in Evaluation and Management

The evolution of the recommended diagnostic approach for previously untreated patients with Hodgkin's disease has paralleled the development and study of aggressive therapeutic programs now available. As successively more detailed techniques have appeared and been utilized, the value and limitations of the earlier techniques have become apparent. This has been especially true for methods of detecting intra-abdominal disease. Enthusiasm initially has been followed by reservation of the value and necessity of inferior venacavography, bipedal lymphography, and now, exploratory laparotomy and splenectomy. These procedures were developed and evaluated by clinical investigators in this field, usually as part of therapeutic protocol studies; they have been rapidly adopted by medical centers and physicians, frequently without a complete appreciation of the requirements of the techniques, the morbidity of the procedures, and their indications based upon available knowledge. This is the current situation for the use of exploratory laparotomy and splenectomy for patients with Hodgkin's disease.