Open splenectomy: Ten-year experience in an oncological referral center

Juan Manuel Ruiz-Molina; Esmeralda Patricia Ochoa-Sánchez; Horacio Noé López-Basave; Jose Luis Barrera-Franco; Aiello Crocifoglio-Vincenzo; Juan Manuel Medina-Castro

2007, Number 3

<< Back Next >>

Cir Cir 2007; 75 (3)

Open splenectomy: Ten-year experience in an oncological referral center

Ruiz-Molina JM, Ochoa-Sánchez EP, López-Basave HN, Barrera-Franco JL, Crocifoglio-Vincenzo A, Medina-Castro JM

Full text

How to cite this article

Language: Spanish
References: 24
Page: 163-168
PDF size: 67.47 Kb.

ABSTRACT

Background: Open splenectomy is a useful procedure for some diseases with splenomegaly › 1500 g. We undertook this study to evaluate open splenectomy morbidity and mortality at the Instituto Nacional de Cancerologia in Mexico City.
Methods: We reviewed the clinical files of patients with benign and malignant hematological diseases, as well as other diseases, who underwent splenectomy from 1994 to 2005.
Results: Twenty five patients with a mean age of 38.5 years were submitted for open splenectomy. Splenomegaly was found in 12 patients (48 %). The most frequent abdominal wall incision was transverse left subcostal (64 %). Average surgical time was 125 min, bleeding 485 ml, spleen weight 1553.6 g and mean size 15 ´ 11 ´ 12 cm. Mean hospital stay was 7.5 days. Eighteen patients (72 %) did not have immediate complications. One patient (4 %) developed surgical wound infection, two patients (8 %) had significant pain, three patients (12 %) had bleeding and one patient (4 %) developed intraabdominal fluid collection. Twenty one patients (84 %) did not have further complications. One patient (4 %) developed multiple organ failure, another patient (4 %) developed thrombocytopenia and another (4 %) developed severe pain. During an average 81-month follow-up we found 14 patients (56 %) asymptomatic, two patients (8 %) with documented tumoral activity (angiosarcoma and non-Hodgkin’s lymphoma) and one patient (4 %) developed a second neoplasm. Six patients (2 %) died due to underlying disease (chronic myeloid leukemia and lymphoma), one patient (4 %) with active disease (Hodgkin’s disease) and one patient (4 %) died due to other causes.
Conclusions: With a spleen › 1500 g, open surgery offers better visibility and, in fact, less morbidity and mortality.

REFERENCES

Rosen W, Brody F, Walsh M, Tarnoff M, Malf J, Ponsky J. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc 2002;16:272-279.
2. Sutherland GA, Burghard FF. The treatment of splenic anemia by splenectomy. Lancet 1916;2:1819-1822.
3. Friedman RL, Fallas MJ, Carroll BJ, et al. Laparoscopic splenectomy for ITP. The gold standard. Surg Endosc 1996;10:991-995.
4. Schwartz SI. Role of splenectomy in hematologic disorders. World J Surg 1996;20:1156-1159.
5. Berman R, Yahanda A, Mansfield P, et al. Laparoscopic splenectomy in patients with hematologic malignancies. Am J Surg 1999;178:530-536.
6. Horowitz J, Smith J, Weber T, et al. Postoperative complications after splenectomy for hematologic malignancies. Ann Surg 1996;223:290-296.
7. Brunt M, Langer J, Quasebarth M, et al. Comparative analysis of laparoscopic versus open splenectomy. Am J Surg 1996;172:596-601.
8. Tagarona E, Espert J, Balagué C, et al. Splenomegaly should not be considered a contraindication for laparoscopic splenectomy. Ann Surg 1998;228:35-39.
9. Malmaeus J, Akre T. Adami HO, Hagberg H. Early postoperative course of following elective splenectomy in haematological diseases: a high complication rate in patients with myeloproliferative disorders. Br J Surg 1986;73:720-723.
10. Dawson AA, Jones PI, King DJ. Splenectomy in the management of hematological disease. Br J Surg 1987;74:353-357.
11. Ellison EG, Fabri PJ. Complications of splenectomy: etiology, prevention and management. Surg Clin North Am 1983;63:1313-1330.
12. Johanson T, Bostrom H, Sjodahl R, Ihse I. Splenectomy for haematological diseases. Acta Chir Scand 1990;156:83-86.
13. Sandusky WR, Leavell BS, Benjamín BI. Splenectomy: indications and results in hematologic disorders. Ann Surg 1964;159:695-709.
14. Wilhem MC, Jones RE, McGehee R, et al. Splenectomy in haematologic disorder: the ever-changing indications. Ann Surg 1988;207:581-589.
15. Damester HL, Ellis LD. Hematologic indications for splenectomy. Surg Clin North Am 1975;55:253-275.
16. Musser G, Lasar G, Hocking W, Busettil RW. Splenectomy for hematological disease. Ann Surg 1984;200:40-45.
17. Nies BA, Creger WP. Tolerance of chemotherapy following splenectomy for leukopenia or thrombocytopenia in patients with malignant lymphomas. Cancer 1967;29:558-562.
18. Gill PG, Souter RG, Morris PJ. Splenectomy for hypersplenism in malignant lymphomas. Br J Surg 1981;68:29-33.
19. Thomas JP, Porcell A, Arthur LS. Splenic angiosarcoma and iron deficiency anemia in a 43-year-old man. South Med J 2001;94:640-643.
20. Tura S, Fiacchini M, Zinzani PL, et al. Splenectomy and the increasing risk of secondary acute leucemia in Hodgkin’s disease. J Clin Oncol 1993;11:925-930.
21. Swerdlow AJ, Douglas AJ, Vaughan-Hudson G, et al. Risk of secondary primary cancer after Hodgkin disease in patients in the British National Lymphoma Investigation: relationships to host factors, histology and stage of Hodgkin disease, and splenectomy. Br J Cancer 1993;68:1005-1111.
22. Mellemkjoer L, Olson JH, Linet MS, et al. Cancer risk after splenectomy. Cancer 1995;75:577-583.
23. Salvagno L, Timorato L, Soraru M, et al. Secondary leukemia following treatment for Hodgkin disease. Tumori 1993;79:103-107.
24. Dietrich PY, Henry-Amar M, Cossel JM, et al. Secondary primary cancers in patients continuously disease-free from Hodgkin disease: a prospective role for the spleen? Blood 1994;84:1209-1215.