Partial splenectomy in children: an alternative for splenectomy in the pathological staging of Hodgkin's disease.
BACKGROUND
The more accurate staging of Hodgkin's disease in children is achieved with a staging laparotomy and splenectomy. A disadvantage of the splenectomy is the high risk for an overwhelming postsplenectomy sepsis (OPSI). Therefore, the partial splenectomy was introduced as an alternative to splenectomy in the staging of Hodgkin's diseases in children.


METHODS
During the period 1982-1988, 12 children with Hodgkin's disease underwent a staging laparotomy with partial splenectomy. All patients were preoperatively vaccinated with Pneumococcus vaccine. The first three patients received 44 Gy locoregional radiotherapy, whereas nine patients received 25 Gy locoregional radiotherapy and two courses of MOPP/ABVD (mitoxin, oncovin [vincristine], procarbazine, prednisone/adriamycin, bleomycin, vinblastine, decarbazine).


RESULTS
The morbidity was negligible. The pathological stage changed in three patients (25%). During a median follow-up of 6 years (range 4-10), no OPSI was diagnosed. One patient developed a secondary leukaemia.


CONCLUSIONS
Staging laparotomy for Hodgkin's disease is being performed with less frequency because the majority of patients are treated with chemotherapy and low-dose radiation therapy. After splenectomy and chemotherapy regimens with alkylating agents, there is an increased risk for secondary acute leukemia. With partial splenectomy an adequate staging of the disease can be achieved, allowing a more tailored therapy so that systemic chemotherapy will not be used as frequently, resulting in a lower treatment morbidity without decreasing survival.
Department of Surgical Oncology, University Hospital Groningen, The Netherlands.
H J
HJ
Hoekstra
R Y
RY
Tamminga
W
W
Timens
D000293:Adolescent; D002648:Child; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009367:Neoplasm Staging; D011182:Postoperative Care; D011300:Preoperative Care; D012086:Reoperation; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome