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. 1994 Jun;219(6):615–624. doi: 10.1097/00000658-199406000-00004

Long-term complications of laparotomy in Hodgkin's disease.

M Jockovich 1, N P Mendenhall 1, M D Sombeck 1, J L Talbert 1, E M Copeland 3rd 1, K I Bland 1
PMCID: PMC1243206  PMID: 8203970

Abstract

OBJECTIVE: The authors determined the incidence of complications in 133 patients who had undergone staging laparotomy with splenectomy before treatment for Hodgkin's disease (stages I-IV). METHODS AND MATERIALS: Medical records were reviewed, and the patients or their relatives were interviewed. Median follow-up after laparotomy was 15.7 years (range = 2.5-28 years). RESULTS: Ten episodes of overwhelming postsplenectomy infection (OPSI) were documented in nine patients (6.8%). None of 25 patients who received pneumococcal vaccine before splenectomy developed OPSI. Patients with advanced (stages III-IV) or recurrent Hodgkin's disease were at higher risk of OPSI than those with early disease, and those who received combined modality oncologic therapy were at greater risk than those receiving less intensive treatment. Surgical complications included small bowel obstruction in 13 patients (9.8%), necessitating repeat laparotomy in 9 patients (6.8%), atelectasis in 17 patients, abscess in 3 patients, and 1 wound dehiscence. No deaths occurred as a result of surgical complications. Causes of death in the 29 patients who died included Hodgkin's disease (12 patients), acute treatment-related morbidity (1 patient), leukemia (5 patients), bone marrow failure (3 patients), solid malignancy (2 patients), intercurrent disease (4 patients), unknown causes (1 patient), and OPSI (1 patient). CONCLUSION: With presplenectomy pneumococcal vaccination and modern surgical techniques, the long-term risks of laparotomy with splenectomy are acceptable if knowledge of the pathologic extent of abdominal Hodgkin's disease would alter treatment regimens.

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Selected References

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  1. Baccarani M., Fiacchini M., Galieni P., Gherlinzoni F., Fanin R., Fasola G., Mazza P., Tura S. Meningitis and septicaemia in adults splenectomized for Hodgkin's disease. Scand J Haematol. 1986 May;36(5):492–498. doi: 10.1111/j.1600-0609.1986.tb02286.x. [DOI] [PubMed] [Google Scholar]
  2. Björkholm M., Askergren J., Holm G., Mellstedt H. Long-term influence of splenectomy on immune functions in patients with Hodgkin's disease. Scand J Haematol. 1980 Jan;24(1):87–94. doi: 10.1111/j.1600-0609.1980.tb01323.x. [DOI] [PubMed] [Google Scholar]
  3. Björkholm M., Wedelin C., Holm G., Johansson B., Mellstedt H. Longitudinal studies of blood lymphocyte capacity in Hodgkin's disease. Cancer. 1981 Nov 1;48(9):2010–2015. doi: 10.1002/1097-0142(19811101)48:9<2010::aid-cncr2820480917>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  4. Chilcote R. R., Baehner R. L., Hammond D. Septicemia and meningitis in children splenectomized for hodgkin's disease. N Engl J Med. 1976 Oct 7;295(15):798–800. doi: 10.1056/NEJM197610072951502. [DOI] [PubMed] [Google Scholar]
  5. Cornbleet M. A., Vitolo U., Ultmann J. E., Golomb H. M., Oleske D., Griem M. L., Ferguson D. J., Miller J. B. Pathologic stages IA and IIA Hodgkin's disease: results of treatment with radiotherapy alone (1968-1980). J Clin Oncol. 1985 Jun;3(6):758–768. doi: 10.1200/JCO.1985.3.6.758. [DOI] [PubMed] [Google Scholar]
  6. Derek R., Jenkin T., Berry M. P. Hodgkin's disease in children. Semin Oncol. 1980 Jun;7(2):202–211. [PubMed] [Google Scholar]
  7. Desser R. K., Ultmann J. E. Risk of severe infection in patients with Hodgkin's disease or lymphoma after diagnostic laparotomy and splenectomy. Ann Intern Med. 1972 Jul;77(1):143–146. doi: 10.7326/0003-4819-77-1-143. [DOI] [PubMed] [Google Scholar]
  8. Donaldson S. S., Glatstein E., Vosti K. L. Bacterial infections in pediatric Hodgkin's disease: relationship to radiotherapy, chemotherapy and splenectomy. Cancer. 1978 May;41(5):1949–1958. doi: 10.1002/1097-0142(197805)41:5<1949::aid-cncr2820410539>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  9. Donaldson S. S., Kaplan H. S. Complications of treatment of Hodgkin's disease in children. Cancer Treat Rep. 1982 Apr;66(4):977–989. [PubMed] [Google Scholar]
  10. Donaldson S. S., Moore M. R., Rosenberg S. A., Vosti K. L. Characterization of postsplenectomy bacteremia among patients with and without lymphoma. N Engl J Med. 1972 Jul 13;287(2):69–71. doi: 10.1056/NEJM197207132870203. [DOI] [PubMed] [Google Scholar]
  11. Eraklis A. J., Kevy S. V., Diamond L. K., Gross R. E. Hazard of overwhelming infection after splenectomy in childhood. N Engl J Med. 1967 Jun 1;276(22):1225–1229. doi: 10.1056/NEJM196706012762203. [DOI] [PubMed] [Google Scholar]
  12. Francke E. L., Neu H. C. Postsplenectomy infection. Surg Clin North Am. 1981 Feb;61(1):135–155. doi: 10.1016/s0039-6109(16)42339-x. [DOI] [PubMed] [Google Scholar]
  13. Gopal V., Bisno A. L. Fulminant pneumococcal infections in 'normal' asplenic hosts. Arch Intern Med. 1977 Nov;137(11):1526–1530. [PubMed] [Google Scholar]
  14. Grimfors G., Söderqvist M., Holm G., Lefvert A. K., Björkholm M. A longitudinal study of class and subclass antibody response to pneumococcal vaccination in splenectomized individuals with special reference to patients with Hodgkin's disease. Eur J Haematol. 1990 Aug;45(2):101–108. doi: 10.1111/j.1600-0609.1990.tb00426.x. [DOI] [PubMed] [Google Scholar]
  15. Hancock B. W., Bruce L., Ward A. M., Richmond J. Changes in immune status in patients undergoing splenectomy for the staging of Hodgkin's disease. Br Med J. 1976 Feb 7;1(6005):313–315. doi: 10.1136/bmj.1.6005.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hancock B. W., Bruce L., Ward A. M., Richmond J. The immediate effects of splenectomy, radiotherapy and intensive chemotherapy on the immune status of patients with malignant lymphoma. Clin Oncol. 1977 Jun;3(2):137–144. [PubMed] [Google Scholar]
  17. Hays D. M., Ternberg J. L., Chen T. T., Sullivan M. P., Fuller L. M., Tefft M., Kung F., Gilchrist G., Fryer C., Heller R. N. Complications related to 234 staging laparotomies performed in the Intergroup Hodgkin's Disease in Childhood study. Surgery. 1984 Sep;96(3):471–478. [PubMed] [Google Scholar]
  18. Hosea S. W., Burch C. G., Brown E. J., Berg R. A., Frank M. M. Impaired immune response of splenectomised patients to polyvalent pneumococcal vaccine. Lancet. 1981 Apr 11;1(8224):804–807. doi: 10.1016/s0140-6736(81)92681-7. [DOI] [PubMed] [Google Scholar]
  19. Krivit W., Giebink G. S., Leonard A. Overwhelming postplenectomy infection. Surg Clin North Am. 1979 Apr;59(2):223–233. doi: 10.1016/s0039-6109(16)41782-2. [DOI] [PubMed] [Google Scholar]
  20. Lanzkowsky P., Shende A., Karayalcin G., Aral I. Staging laparotomy and splenectomy: treatment and complications of Hodgkin's disease in children. Am J Hematol. 1976;1(4):393–404. doi: 10.1002/ajh.2830010405. [DOI] [PubMed] [Google Scholar]
  21. Lockwood C. M. Immunological functions of the spleen. Clin Haematol. 1983 Jun;12(2):449–465. [PubMed] [Google Scholar]
  22. Mauch P., Tarbell N., Weinstein H., Silver B., Goffman T., Osteen R., Zajac A., Coleman C. N., Canellos G., Rosenthal D. Stage IA and IIA supradiaphragmatic Hodgkin's disease: prognostic factors in surgically staged patients treated with mantle and paraaortic irradiation. J Clin Oncol. 1988 Oct;6(10):1576–1583. doi: 10.1200/JCO.1988.6.10.1576. [DOI] [PubMed] [Google Scholar]
  23. Mendenhall N. P., Cantor A. B., Williams J. L., Ternberg J. L., Weiner M. A., Kung F. H., Marcus R. B., Jr, Ferree C. R., Leventhal B. G. With modern imaging techniques, is staging laparotomy necessary in pediatric Hodgkin's disease? A Pediatric Oncology Group study. J Clin Oncol. 1993 Nov;11(11):2218–2225. doi: 10.1200/JCO.1993.11.11.2218. [DOI] [PubMed] [Google Scholar]
  24. Pedersen F. K., Henrichsen J., Schiffman G. Antibody response to vaccination with pneumococcal capsular polysaccharides in splenectomized children. Acta Paediatr Scand. 1982 May;71(3):451–455. doi: 10.1111/j.1651-2227.1982.tb09451.x. [DOI] [PubMed] [Google Scholar]
  25. Rosenberg S. A. Splenectomy in the management of Hodgkin's disease. Br J Haematol. 1972 Sep;23(3):271–276. doi: 10.1111/j.1365-2141.1972.tb08872.x. [DOI] [PubMed] [Google Scholar]
  26. Rosenstock J. G., D'Angio G. J., Kiesewetter W. B. Proceedings: The incidence of complications following staging laparotomy for Hodgkin's disease in children. Am J Roentgenol Radium Ther Nucl Med. 1974 Mar;120(3):531–535. doi: 10.2214/ajr.120.3.531. [DOI] [PubMed] [Google Scholar]
  27. Schimpff S. C., O'Connell M. J., Greene W. H., Wiernik P. H. Infections in 92 splenectomized patients with Hodgkin's disease. A clinical review. Am J Med. 1975 Nov;59(5):695–701. doi: 10.1016/0002-9343(75)90230-2. [DOI] [PubMed] [Google Scholar]
  28. Schneeberger A. L., Girvan D. P. Staging laparotomy for Hodgkin's disease in children. J Pediatr Surg. 1988 Aug;23(8):714–717. doi: 10.1016/s0022-3468(88)80408-1. [DOI] [PubMed] [Google Scholar]
  29. Siber G. R., Gorham C., Martin P., Corkery J. C., Schiffman G. Antibody response to pretreatment immunization and post-treatment boosting with bacterial polysaccharide vaccines in patients with Hodgkin's disease. Ann Intern Med. 1986 Apr;104(4):467–475. doi: 10.7326/0003-4819-104-4-467. [DOI] [PubMed] [Google Scholar]
  30. Weitzman S. A., Aisenberg A. C., Siber G. R., Smith D. H. Impaired humoral immunity in treated Hodgkin's disease. N Engl J Med. 1977 Aug 4;297(5):245–248. doi: 10.1056/NEJM197708042970504. [DOI] [PubMed] [Google Scholar]

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