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Exploratory laparotomy with splenectomy was performed before or after multiple chemotherapy in 182 patients with clinically localised Hodgkin's disease in clinical stages IB, II3A, IIB, III A and III B. There was a 50% probability of clinically not diagnosed infradiaphragmatic involvement in patients with clinically localised stage IB, II B or II3A. Restaging was necessary in 20% of patients with clinical stage III, because infradiphragmatic involvement was histologically not demonstrable. Infradiaphragmatic involvement occurred in 12% of patients who had received six chemotherapy cycles according to the MOPP scheme, before exploratory splenectomy. When chemotherapy produced complete clinical remission, only 2.7% patients had any infradiaphragmatic involvements. Exploratory laparotomy with splenectomy is not required, therefore, in such patients.

A retrospective analysis on 482 patients with localised Hodgkin's disease revealed that none of those with primary high-cervical or primary infradiaphragmatic involvement had any infiltration of the mediastinum, either at the time or later. As a result, prophylactic mediastinal radiation was not practised if high-cervical or infradiaphragmatic lymph-nodes had been affected first. None of these patients had any mediastinal recurrence after at least seven years.

The effectiveness of three and six cycles of MOPP (chlormethine, vincristine, procarbazine and prednisolone) as initial chemotherapy in 108 patients with Hodgkin's disease at clinical stages II nA, IIB, IIIA and B was compared in a study of two groups, one of them treated in six cycles (October, 1972--December, 1976), the other in three cycles (January, 1977--October, 1979). The clinically complete remissions obtained by this schedule and findings at exploratory splenectomy were chosen as measures of effectiveness. The frequency of clinically complete remission was similar in both groups. In 96% (97% for the second group) of patients in whom the three (six) MOPP cycles of cytostatic treatment achieved clinically complete remission, exploratory splenectomy failed to reveal any infradiaphragmatic involvement. In patients in stage IIA and IIB one can, therefore, consider reducing primary cytostatic treatment to three MOPP cycles. Exploratory splenectomy and prophylactic infradiaphragmatic radiotherapy can be omitted in these patients, if one accepts the 5% risk of infradiaphragmatic involvement. Splenectomy can also be omitted in patients in stage III, but not infradiaphragmatic radiotherapy, including that no the spleen.