In girls, if pelvic irradiation is anticipated, oophoropexy with transposition of the ovaries to a midline position should be performed. In all cases, there should be consultation between the pediatric oncologist, radiation oncologist, and surgeon prior to the staging operation. Patients who have had a splenectomy are susceptible to sepsis with encapsulated organisms. They should be given HIB and Pneumovax before splenectomy, if possible, and daily prophylactic penicillin thereafter. The staging classification that is currently used for Hodgkin's disease was adopted at the Ann Arbor Conference held in 1971.
Extralymphatic disease presents confusing problems in staging.
For example, a patient with disease in the chest and neck, with systemic symptoms, and a negative lymphangiogram, might be found at laparotomy to have involvement of the spleen, liver, and bone marrow. Dudgeon DL, Kelly R, Ghory MJ, et al. The efficacy of lymphangiography in the staging of pediatric Hodgkin's disease. Azizkhan RG, Dudgeon DL, Buck JR, et al. Pulmonary function is compromised in children with mediastinal lymphoma.