Lymphomas Cancer

Reasoning

With easy availability of imaging, staging laparotomy, which was standard procedure for lymphomas, became obsolete. Staging laparoscopy may spare patients the morbidity of an unnecessary laparotomy and provide tissue to confirm the diagnosis of non-Hodgkin lymphoma or allow the surgical staging of Hodgkin lymphoma. Staging laparoscopy can also be used for patients who need laparoscopic splenectomy as treatment and may lead to less pain, faster recovery, and earlier time to definitive treatment.

Hodgkin’s lymphoma originates in one nodal group and spreads in a stepwise manner to contiguous nodal groups. Staging laparoscopy may be useful in determining the stage and location of the disease, as this may affect decisions regarding treatment, particularly the administration of chemotherapy.

In contrast, for non-Hodgkin lymphoma, the exact extent of the disease has less impact on the treatment course, and therefore, staging laparoscopy in non-Hodgkin lymphoma is less frequently performed. The primary indication for staging laparoscopy in non-Hodgkin lymphoma is for tissue diagnosis through biopsy of intra-abdominal lymph nodes in the absence of peripheral lymphadenopathy. Retroperiteal or mediastinal lymphadenopathy with failed diagnosis on truecut biopsy is an indication for diagnostic scopy and biopsy of the lymphnodes

Indications

Tissue diagnosis and biopsy of intra-abdominal lymphadenopathy in the absence of peripheral lymphadenopathy, especially for non-Hodgkin’s lymphoma cases and when core needle biopsy has been non-diagnostic
Accurate staging in Hodgkin’s lymphoma when staging affects decisions for appropriate treatment or prognosis
Restaging after treatment or when recurrence is suspected

Contraindications

There have been no specific contraindications reported for SL in lymphoma.

Technique

Patients are commonly placed at a 45-degree angle, left decubitus position. A laparoscopic hand-assisted technique is often used, especially when splenectomy is planned. The steps of staging laparoscopy are similar to the traditional open procedure:

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Inspection for gross abnormalities

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Core liver biopsy of each hepatic lobe and wedge biopsy of left lateral liver segment

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Laparoscopic ultrasound to search for hepatic lesions

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Splenectomy with removal of organ intact

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Lymph node sampling of the following areas: iliac, celiac, portal, mesenteric, and peri-aortic

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Lymph node excision of abnormal nodes identified on preoperative testing with application of clips at those excision areas

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Oophoropexy posterior to the uterus

Evidence

The quality of the available literature for staging laparoscopy in lymphoma is primarily limited to retrospective reviews. In addition, the number of available studies is quite small. Furthermore, some studies compare the accuracy of the procedure with historical controls for open surgery, which increases the bias of the results. Surgical technique differs according to the institution and surgeon experience, making generalizations difficult and strong recommendations impossible. Data on the accuracy of the procedure come mainly from feasibility studies and are sparse. Compared with percutaneous biopsy, laparoscopic biopsy was demonstrated to have superior sensitivity (87% vs. 100%, respectively), specificity (93% vs. 100%, respectively), and accuracy (33% vs. 83%, respectively). With the available evidence staging laparoscopy in lymphoproliferative disorders is safe and effective.

References

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Asoglu O, Porter L, Donohue JH, Cha SS. Laparoscopy for the definitve diagnosis of intra-abdominal lymphoma. Mayo Clin Proc 2005;80:625-631.

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Baccarani U, Carroll BJ, Hiatt JR, et al. Comparison of laparoscopic and open staging in Hodgkin disease. Arch Surg 1998; 133:517-522.

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Silecchia G, Raparelli L, Perrotta N, et al. Accuracy of laparoscopy in the diagnosis and staging of lymphoproliferative diseases. World J Surg 2003;27:653-658.