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July 23, 1973

Staging of Hodgkin Disease by Laparotomy

Author Affiliations

Good Samaritan Hospital Portland, Ore

JAMA. 1973;225(4):416-417. doi:10.1001/jama.1973.03220310050018

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To the Editor.—  In their retrospective report, Smith et al (224:1026, 1973) concluded that "... with stage I or II disease above the diaphragm, laparotomy is not necessary if extended field and splenic irradiation is administered." I would surely agree with this conclusion and congratulate the authors on their logic. At the present state of the art, the only chance for cure with patients with Hodgkin disease resides in intensive x-ray therapy. If one intends to irradiate the abdomen, it is not necessary to have the patient undergo a laparotomy merely for the sake of reclassifying patients from stage II to III or IV.However, the authors recommend laparotomy for patients who initially have stage II or IV disease. They justify this on the basis of several false positive lymphangiograms on patients originally classified as stage III, and the false conclusion that two patients were stage IV because of either an