The Decision to Perform Staging Laparotomy in Symptomatic Hodgkin's Disease

C. J. Rutherford, J. F. Desforges, B. Davies, A. I. Barnett

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

. This study defines patients with symptomatic Hodgkin's disease for whom risks of staging laparotomy (LAP) outweigh benefits conferred by accurate knowledge of stage. From a database of more than 900 pathologically‐staged patients, probabilities of pathological stage are calculated for combinations of basic findings and lymphangiogram results. Decision‐making thresholds are defined at which results of treatment after LAP, taking operative mortality into account, are equivalent to immediate treatment appropriate to clinical stage. These thresholds are substantially altered by varying LAP mortality estimates, by assigning a false negative rate to LAP, and by considering uncertainty in treatment results. Fifty‐four combinations of findings are described for which immediate therapy with MOPP is justified; total nodal irradiation (TNI) is never indicated in B patients without prior LAP staging. Analysing 94 B patients who had LAP showed an appreciable number might have been spared this, particularly when uncertainty in treatment results is considered. With 0.03 (= 3%) uncertainty in treatment results, and 1% LAP mortality, LAP was not indicated in one in seven patients; nearly one third of patients should have immediate treatment with 3% LAP mortality. Threshold analysis can define those patients for whom risks of LAP outweigh benefits.

Original languageEnglish (US)
Pages (from-to)347-358
Number of pages12
JournalBritish Journal of Haematology
Volume44
Issue number3
DOIs
StatePublished - Mar 1980

ASJC Scopus subject areas

  • Hematology

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