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PubMed2004

The pattern of indications and complications of splenectomy in Eastern Saudi Arabia.

OBJECTIVE: The indications for splenectomy have changed over the past decade. Trauma and hematological diseases are emerging as common indications since the early eighties of the last century. This study looks at the pattern of indications and complications of splenectomy at Dammam Central Hospital, Dammam, Eastern Province, Kingdom of Saudi Arabia. METHODS: A retrospective study of all patients who underwent splenectomy at Dammam Central Hospital over the 5-year period (1996-2000). RESULTS: There were 55 patients (47 males and 8 females) who underwent splenectomy over the study period. The mean age was 57.5 (range 4-65) years. The most common indication was trauma (43.6%) followed by hematological reasons (25.5%), which were mainly in sickle cell disease (SCD) patients (N=9). Splenic sequestration crises were the most common indication in SCD patients (77.7%). The mean weight of the excised spleen was 882.7 (range 85-1350) grams. There were 16 (29%) postoperative complications mostly encountered in patients with portal hypertension (46.2%). There were 2 deaths (3.6%) as a result of pulmonary embolism in a trauma patient and multi-organ failure in SCD. There was no reported postsplenectomy sepsis after a follow-up period of 18-72 months. CONCLUSION: The most common indication for splenectomy in Dammam is abdominal trauma, followed by hematological diseases. Splenectomy in adult SCD population is uncommon. Conventional splenectomy has 29% complication rate especially in patients with portal hypertension. This calls for rapid introduction of minimally invasive approach to reduce the morbidity associated with open splenectomy.

Adolescent↗

PubMed1989

Splenectomy for hematologic disease.

Splenectomy has a major role in the treatment of hematologic diseases. Although it is rarely curative, splenectomy removes the site of the destruction or sequestration of erythrocytes, leukocytes, and platelets. Destruction occurs in such diseases as hemolytic anemia and ITP, whereas sequestration occurs as an idiopathic disease or secondary to a host of other diseases described above. Splenectomy is also indicated for symptomatic splenomegaly associated with leukemia, lymphoma, or myeloproliferative disorders. It is palliative, increasing the comfort of the patient by removing a massive spleen. Splenectomy also serves as a staging tool in lymphoma, Hodgkin's disease, and NHL, although it is much more beneficial in Hodgkin's disease, owing simply to stage at presentation. Splenectomy can be performed safely with minimal risk in most patients, but certain diseases carry increased risks of fatality and complications. Such diseases include leukemia, lymphoma, and myeloproliferative disorders, but even in these, splenectomy may be indicated in a select group of patients. The decision to perform splenectomy should therefore be made individually in these cases. Because it can be palliative in some cases, splenectomy can play a role in patient management, even though it may not alter survival.

Hematologic Diseases↗

PubMed1989

Splenectomy and the sick asplenic patient.

The sick asplenic patient bears risk to infectious complications and mortality. That risk is not widely accepted since no specific syndrome is applicable to all asplenic patients who are ill. In order to determine outcome following splenectomy, 624 patients having simple splenic injury, splenic plus multisystem trauma, elective splenectomy, incidental or accidental splenectomy, or splenectomy associated with transplantation were studied. Nonfatal complications specifically related to splenectomy occurred in 23 per cent of patients with multiorgan injury and 18 per cent with incidental-accidental splenic removal; splenectomy associated with transplantation had the highest mortality. The classic postsplenectomy sepsis syndrome was encountered late only twice. In the already sick patient rendered asplenic, conditions heralding susceptibility to progressive and sometimes fatal infection must be considered at all times. Sound indications for splenectomy must prevail before splenic removal since morbidity and mortality follow splenectomy, especially in the sick asplenic patient.

Adult↗

PubMed1989

[Effect of splenectomy on the growth of implanted hepatoma and peripheral T-cell subsets in the rat].

In order to explore further the mechanisms of effect of splenectomy on tumor growth, a model of intrahepatic implanted hepatoma in rats was used to observe the interactions between tumor growth and alterations of T-cell subsets following splenectomy. A malignant hepatoma mass was implanted into the liver immediately after splenectomy. In the meanwhile, peripheral blood was collected to evaluate T-cell subsets successively. Other three groups of rats, health splenectomy health sham-splenectomy and hepatoma bearing sham-splenectomy were used as controls. It was showed that in splenectomized rats bearing-hepatoma, the reduction of pan T cells, T h/i cells, the increase of mean tumor diameter, the incidence of tumor metastasis, and the amount of ascites were all statistically different from control groups (P less than 0.01). Our findings were that splenectomy enhanced the hepatoma growth and reduced the T h/i cells in peripheral blood, which suggested that the disturbance of the equation of T-cell subsets probably contributed to facilitating tumor growth following splenectomy.

Animals↗

PubMed1977

Effect of splenectomy in tumor-bearing mice and gastric cancer patients.

In order to investigate the effect of splenectomy on tumor growth, splenectomy was performed in DDS mice transplanted subcutaneously with Ehrlich ascites tumor cells before and after the transplantation. It was found that, in the first control group receiving sham operation, all the mice died of tumor; in the second group that underwent splenectomy 1 week before the transplantation the tumor regressed in every case; in the third group that received splenectomy 5 days after transplantation when tumor became established, the tumor regression was observed in 85% of the animals, and in the fourth group that underwent splenectomy 10 days after transplantation, all the animals died of tumor earlier than the sham-operated first group. In the follow-up observations of 389 patients with gastric cancer who underwent gastrectomy alone and 89 cases who received gastrectomy combined with splenectomy, the 5-year survival rate of the latter group tended to show a better prognosis in a relatively early stage. It was concluded that splenectomy might inhibit the growth of tumor in a certain early stage, in both animals and humans, and the possible mechanism of this effect of splenectomy was discussed from the immunological aspects.

Animals↗

PubMed1984

[Experimental studies on the rat-model for partial splenectomy and on spleen regeneration].

Partial splenectomy is often preferred to total splenectomy as a method to prevent serious post-operative sepsis. However, most of the previous researches on spleen function following partial splenectomy have failed to provide accurate data on the minimum increase of residual spleen in weight necessary for protection against postoperative sepsis. This is not only to the lack of appropriate model but also to the negligence of the effects of spleen regeneration after partial splenectomy. To produce an accurate model for partial splenectomies, and to know how the spleen regenerates following partial resection, about 500 rats underwent partial splenectomies. From these experiments, the following results were obtained. These partial splenectomies based on length of the spleen were satisfactory models as partial splenectomy. Absolute volume of regenerated spleen was finally almost the same in every model. However, the less the remnant spleen was the longer period was necessary until the spleen regeneration completed.

Animals↗

PubMed1996

The effect of splenectomy for hypersplenism on whole body protein turnover, resting metabolic rate and growth in sickle cell disease.

OBJECTIVE: To determine whether, in the same individual, an observed fall in whole body protein turnover following splenectomy in children with hypersplenism and homozygous sickle cell (SS) disease is associated with a measurable fall in resting metabolic rate (RMR) and an increase in rate of growth. SUBJECTS: Six children (5 SS disease, 1 S beta degree thalassaemia), aged 68 to 126 months, were studied before and after splenectomy for hypersplenism. DESIGN: Protein turnover was measured by the end product method using prime/intermittent oral doses of 15N-glycine and RMR by indirect calorimetry before preoperative transfusion and repeated at least eight weeks after splenectomy. Height and weight velocities were measured over six month periods before and after splenectomy. SETTING: University Hospital of the West Indies in Jamaica and the Medical Research Laboratories (Jamaica). RESULTS: After splenectomy protein turnover fell significantly by 30% and RMR by 34 kJ/kg/d. Mean weight velocity which was below normal before surgery, z = -2.3, improved significantly after surgery, z = 0.7, (P = 0.03). Height velocity increased in two children but the mean height velocity did not change following splenectomy. The reduction in protein turnover was estimated to account for 62% of the fall in RMR. CONCLUSION: This study confirms that there is a significant reduction in energy expenditure following splenectomy for hypersplenism in SS disease. A reduction in protein turnover was a major contributor to the saving in energy, although it is not clear whether it accounted for all. In the present group of children the energy saved was associated with an improvement in the wasting present before splenectomy.

Anemia, Sickle Cell↗

PubMed1997

[Comparative study of the protective role of the vaccine against Haemophilus influenzae type b and partial splenectomy in an experimental model].

BACKGROUND: Although the vaccine against Haemophilus influenzae type b has demonstrated its efficacy in children, this bacteria continues to be a cause or overwhelming sepsis in splenetomized patients. METHODS: To compare the degree of protection provided by partial splenectomy and the conjugated diptheria toxoid vaccine against H. influenzae type b, the bacteremia generated 24, 48 and 96 hours after intravenous inoculation with this bacteria at concentrations of 5 x 10(14), 5 x 10(13) and 5 x 10(12) colony-forming units was assessed in rats subjected to total splenectomy, with and without previous vaccination, to partial splenectomy or to sham operation. RESULTS: With respect to both the proportion of positive blood cultures and the concentration of H. influenzae in the blood stream, the sham-operated control rats and those vaccinated prior to splenectomy presented similar behaviors; the widest differences with respect to the latter two groups were found in the nonvaccinated total splenectomy rats, and the results with the partial splenectomy group fell between these two extremes. CONCLUSIONS: The protection of H. influenzae type b vaccine against infection is equivalent to that provided by the intact spleen for inoculum concentrations of 5 x 10(13) colony-forming units and less. Thus, the possibility of its systematic use in asplenic patients should be considered. The protection provided by the remnant spleen following 50% splenectomy is intermediate between those observed with eusplenia and with asplenia. These results suggest that when partial splenectomy is to be performed in normal spleen, the attempt should be made to conserve as much of the organ as possible.

Animals↗

PubMed1997

[Indications, technique and outcome of laparoscopic splenectomy].

Since introduction of stapling instruments, which allow a safe hemostasis of hilar spleen vessels, the advantages of laparoscopic procedures are as well available for the laparoscopic splenectomy, like atraumatic dissection, reduced hospital stay, less bleeding and therefore less necessity of blood transfusion, and reduced analgetic consume. Laparoscopic splenectomy causes a lower morbidity comparing to open conventional splenectomy. Frequent indications for elective splenectomy are immune thrombocytopenic purpura, spherocytosis, Non Hodgkin Lymphoma and Hodgkin's disease. Limiting factors to laparoscopic splenectomy may be the size of spleen, concomiting diseases as portal hypertension and adhesions in upper left abdomen. To remove a big sized spleen we placed it within a large specimen retrival bag, which was partly delivered through a port in the left flank to allow digital morcellation of the spleen and piecemal removal. Eight females and fifteen males with a median age of 45 years (16-73) underwent splenectomy of immune thrombocytopenic purpura (14), spherocytosis (2), Non Hodgkin Lymphoma (5), Hodgkin's disease (1) and hair cell leukemia (1) with a spleen weight of 985 grams. The median operating time was 94 min (40-165) and median blood loss was 214 ml (50-400). Accessory spleens were removed in two cases. The median postoperative hospital stay was 5.6 days (3-10). The only complication was a parechymatous bleeding which needed conversion to open splenectomy. With careful selection of patients, laparoscopic splenectomy can be safely performed on normal and even enlarged spleens. The lateral approach is safe and offers excellent visualization of the splenic vessels, pancreas, and accessory spleens.

Adolescent↗

PubMed1998

Laparoscopic splenectomy: lessons from the learning curve.

OBJECTIVE: Initial reports suggest that laparoscopic splenectomy is a difficult procedure with a steep learning curve and limited scope. The objective of this study was to review various approaches to simplify the operation. DESIGN: A descriptive study of a prospective database. SETTING: A tertiary care teaching hospital. PATIENTS: Fifty-one consecutive patients, seen over a 4-year period, who underwent laparoscopic splenectomy (partial laparoscopic splenectomy in 1 patient) for a wide variety of disorders. INTERVENTIONS: Anterior and lateral surgical approaches to laparoscopic splenectomy and the selective use of preoperative splenic artery embolization. MAIN OUTCOME MEASURES: Blood loss, morbidity, mortality and rate of conversion to open splenectomy, operating time and postoperative hospital stay. RESULTS: The morbidity (11%), death rate (2%), and rate of conversion were low. The recovery rate of accessory spleens was high (24%). Average operating time (3 hours), postoperative stay (3 days) and volume of blood loss improved with time. CONCLUSIONS: Laparoscopic splenectomy is a reliable procedure for patients with spleens less than 20 cm long. For spleens 20 to 30 cm long, preoperative embolization is advisable, and the surgeon should be experienced. Laparoscopic splenectomy should not be performed for spleens more than 30 cm long. The lateral approach has eliminated most of the difficulty with this procedure for spleens less than 20 cm long (no embolization). The anterior approach is reserved for large spleens and partial laparoscopic splenectomy (with embolization).

Adolescent↗

PubMed1999

Suppression of T-cell function in gastric cancer patients after total gastrectomy with splenectomy: implications of splenic autotransplantation.

Background. In Japan since the 1960s, patients with gastric cancer have routinely had splenectomy combined with gastrectomy to ensure that lymph node dissection is complete. However, the influence of splenectomy on long-term immunity is unclear.METHODS: Forty-nine gastric cancer patients who underwent total gastrectomy for cure with ( n = 25) and without ( n = 24) splenectomy were assessed for immunologic function, including the proportion of lymphocyte subsets, purified protein derivative from tuberculin (PPD) response, natural killer (NK) activity, and phytohemagglutinin (PHA) response.RESULTS: Peripheral T-cell mediated functions, e.g., PPD and PHA response, were significantly suppressed in patients who underwent gastrectomy with splenectomy compared with those who had gastrectomy alone. Decreased T-cell subsets (CD 3+, 4+, 8+) and increased NK cell subsets (CD 16+, 57+) were observed in patients who underwent splenectomy. Patients who did not undergo splenectomy had immunologic responses within the normal range.CONCLUSIONS: Splenectomy decreased T-cell mediated responses over the long term. As a potential means to co-rrect this T-cell dysfunction in patients with splenectomy, splenic autotransplantation should be considered in future research.

Journal Article↗

PubMed2000

Complications of laparoscopic splenectomy.

HYPOTHESIS: Analysis of the type and characteristics of complications after laparoscopic splenectomy may permit the identification of clinical factors with predictive value for the development of complications. DESIGN: Univariate and multivariate analysis of factors related to complications in a prospective series of laparoscopic splenectomies. SETTING: A large tertiary referral university-teaching general hospital. PATIENTS: One hundred twenty-two nonselected consecutive patients, in whom laparoscopic splenectomy was attempted between February 1993 and July 1999. INTERVENTION: Laparoscopic splenectomy. MAIN OUTCOME MEASURES: Immediate complications classified according to the Clavien score. Univariate and multivariate analyses were performed of complications related to age, sex, body mass index, and malignant nature of the hematologic disease; preoperative hematocrit and platelet count; operative time; operative position; need of accessory incision; transfusion status; learning curve; and existence of comorbid diseases. RESULTS: One hundred thirteen laparoscopic splenectomies were completed (conversion rate, 7.4%). Twenty patients (18%) developed 23 complications. All were Clavien type I or II, without mortality. One complication was intraoperative (diaphragmatic perforation), and 22 were postoperative: 6 pulmonary (26%), 3 fever (13%), 8 hemorrhagic (35%) (5 episodes of postoperative bleeding and 3 abdominal wall hematomas), and 6 others (26%). Ten (43%) of the 23 were technically related. Univariate analysis showed that complications were only related to age (mean +/- SD, 55 +/- 15 vs 39 +/- 17 years; P<.008) or transfusion (50% vs 11%; P<.001). Multivariate analysis showed that the learning curve (P<.005; 95% confidence interval, 2.46), age (P<.001; 95% confidence interval, 1. 04), spleen weight (P<.009; 95% confidence interval, 1.00), and malignant neoplasm diagnosis (P<.007; 95% confidence interval, 3.82) were independent predictors of complications. CONCLUSIONS: Laparoscopic splenectomy is feasible, and the incidence of severe complications is reduced. However, a high proportion of these complications are technique related. Laparoscopic splenectomy requires great technical care but offers major clinical advantages, even in less favorable situations, such as in patients with splenomegaly or with malignant neoplasms.

Adult↗

PubMed1989

Splenectomy. The treatment of choice for human immunodeficiency virus-related immune thrombocytopenia?

Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus. From November 1985 to February 1988, 15 patients who were human immunodeficiency virus-positive underwent splenectomy for refractory immune thrombocytopenia. Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy. Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period. The median duration of thrombocytopenia prior to surgical therapy was 6 months. A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes. All patients had a therapeutic response to splenectomy. Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months. Splenectomy can be accomplished with an acceptable morbidity. Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis. They had received vaccinations against encapsulated organisms preoperatively. We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia. Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Effect of splenectomy on morbidity and survival following curative gastrectomy for carcinoma.

We performed a retrospective analysis of 392 patients who underwent curative resection of gastric adenocarcinoma to evaluate the impact of splenectomy on survival from gastric cancer and postoperative morbidity. Twelve factors, including splenectomy, were associated with a poor prognosis by univariate analysis. Multivariate analysis identified six of these factors, but not splenectomy, as independently predictive of death due to gastric cancer. The apparent adverse effect of splenectomy was due to its association with other significant risk factors. Postoperative complications occurred more commonly in patients who underwent splenectomy than in those who did not (45% vs 21%); patients in the splenectomy group also had a higher percentage of infectious complications than those in the nonsplenectomy group (75% vs 47%). We conclude that splenectomy has no direct influence on survival, but that it increases the morbidity of curative gastrectomy and should be avoided unless the spleen is close to or invaded by the tumor.

Adenocarcinoma↗

PubMed2001

Response to high-dose intravenous immune globulin as a valuable factor predicting the effect of splenectomy in chronic idiopathic thrombocytopenic purpura patients.

This study was conducted to verify whether the response to high-dose intravenous immune globulin (IVIG) was related to the effect of splenectomy in chronic idiopathic thrombocytopenic purpura (ITP) patients. A total of 79 patients over 16 years of age were enrolled in this study. The response to the treatment was classified on the basis of the platelet count as no response (NR, <50 x 10(9)/l), incomplete response (IR, (50-150) x 10(9)/l), and complete response (CR, >150 x 10(9)/l). The response was evaluated after the infusion of high-dose IVIG, within 2 weeks after splenectomy (immediate response), and during a follow-up period of more than 6 months after splenectomy (sustained response), respectively. 58 patients (73.4%) showed responses (CR or IR) to high-dose IVIG. After splenectomy, immediate responses were observed in 73 patients (92%). The response to high-dose IVIG had no relationship with the immediate response to splenectomy (P = 0.333). A follow-up evaluation was possible with 58 patients; 6 patients with NR in immediate responses did not show any response during the follow-up period, and 17 patients relapsed within 6 months after immediate responses, so 35 patients (60.3%) had sustained responses. Responders to IVIG had significantly higher sustained response rates to splenectomy than non-responders (62% vs. 38%, P = 0.001). These results indicate that the response to high-dose IVIG could be a valuable factor predicting the sustained response to splenectomy in chronic ITP patients.

Adult↗

PubMed1986

Splenectomy for hairy cell leukemia. A clinical review of 63 patients.

To further define the role of splenectomy in hairy cell leukemia (HCL), 63 patients who underwent splenectomy for symptomatic cytopenias or splenomegaly associated with HCL were reviewed. Hematologic response to splenectomy was assessed 6 months postsplenectomy by a modification of Catovsky's criteria. The prognostic value of individual clinical findings, hematologic parameters, spleen size, and Jansen stage were examined by the Cox proportional hazards model. Twenty-one patients were excluded from hematologic response analysis for the following reasons: eight patients died between 1 and 6 months after splenectomy was performed; in seven patients hematologic data were unavailable; and six patients did not have significant preoperative cytopenias. Of 42 remaining patients, hematologic response was complete in 67%, partial in 19%, and there was no response in 14%. Overall, 44% of patients had disease progression within 5 years of splenectomy. Thirteen patients had a leukemic progression 1 year after splenectomy was performed. Overall 5-year survival was 61%. There was no operative mortality (30-day), and only 9% of patients had complications. Survival rates after complete, partial, and no response were 62%, 57%, and 75%, respectively at 5 years. Preoperative clinical findings, hematologic data, spleen size, or Jansen stage were not predictive of survival. Despite the absence of identifiable prognostic criteria, splenectomy continues to be advocated for symptomatic cytopenias and splenomegaly of hairy cell leukemia because of its safety and efficacy.

Adult↗

PubMed1991

Splenectomy does not correlate with length of survival in patients undergoing curative total gastrectomy for gastric carcinoma. Univariate and multivariate analyses.

The relationship between splenectomy and survival time after curative total gastrectomy for advanced gastric cancer was examined by reviewing retrospectively data on 252 patients treated in our clinics between 1965 and 1985. One hundred three patients (40.9%) did not undergo splenectomy and 149 (59.1%) did. In patients subjected to splenectomy, advanced stages of the malignancy were more frequent and metastasis was noticed in 8.1% of splenic hilar lymph nodes and in 10.1% of the lymph nodes associated with the splenic artery. A univariate analysis revealed that the survival time of patients with splenectomy was significantly less than those for whom splenectomy was not done (P less than 0.05). In a subgroup of our patients stratified to adjust for the stage of disease, there was no significant difference between the survival rates. Subsequently, multivariate analysis using the Cox regression analysis adjusted for sex, age, and other covariates indicated that serosa invasion, lymph node metastasis, and tumor size were the most important prognostic factors, and there was no correlation whatever with splenectomy. Our findings rule out any relationship between splenectomy and length of survival time in patients undergoing curative total gastrectomy for advanced gastric cancer.

Carcinoma↗

PubMed1995

Cancer risk after splenectomy.

BACKGROUND: Splenectomy may have an impact on immunologic function. To the authors' knowledge, the only previous epidemiologic study investigating cancer risk among patients splenectomized because of trauma reported no increased cancer risk. In contrast, several investigations have suggested that splenectomy in patients with Hodgkin's disease increases the risk for secondary leukemia independent of treatment. METHODS: To evaluate the cancer risk of patients who underwent splenectomy after traumatic rupture of the spleen, 1103 patients were identified between 1977 and 1989 through Danish hospital discharge records. Another 5212 splenectomized patients also were identified to perform additional analyses for assessing cancer risk subsequent to splenectomy for nontraumatic indications including benign and malignant conditions. Cancer occurrence was determined by performing a linkage to the Danish Cancer Registry. For comparison, expected numbers of cases of cancer were calculated from national cancer incidence rates. RESULTS: The number of cancer cases observed among posttraumatic splenectomized patients matched the expected number (relative risk = 1.0; n = 20; 95% confidence interval = 0.6-1.6) in an average follow-up of 6.8 years. Additional analyses identified possible excesses of a number of site-specific neoplasms among certain subgroups of patients undergoing splenectomy for nontraumatic reasons, but the numbers in the subgroup analyses were small. CONCLUSIONS: No increased risk for cancer was observed among patients who underwent splenectomy because of trauma. However, an increased risk for some specific cancer sites was found in patients who underwent splenectomy for nontraumatic reasons, although the effect of treatments for underlying disease and lifestyle habits such as cigarette smoking could not be ruled out in explaining these excess risks.

Adolescent↗