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PubMed1985

Hematological and oncological indications for splenectomy in children.

The most common hematologic and oncologic indications for splenectomy in childhood are hereditary spherocytosis, chronic idiopathic thrombocytopenic purpura, hypersplenism, and Hodgkin's disease. Because of the increased incidence of septic complications after splenectomy, benefits to be gained from the operation should be weighed against the risks. A retrospective study was done on the charts of 42 consecutive children with hematologic and oncologic disorders, who underwent splenectomy between 1967 and 1982. The incidence of septic complications after splenectomy was 12%; sepsis, however, only occurred in patients with severe underlying diseases (three patients with Hodgkin's disease, one patient with systemic lupus erythematosus, and one patient with chronic pseudo-malignant immunoproliferation). In contrast, none of the patients who were splenectomized for other reasons (mainly hereditary spherocytosis and chronic immune thrombocytopenic purpura) had a septic complication. Two patients with end-stage Hodgkin's disease (5%) experienced fatal septic complications. Although splenectomy is well established for diagnostic and therapeutic considerations in patients with Hodgkin's disease, not all of them might benefit from this operation, and studies with a more limited approach to splenectomy might prove to be of the same therapeutical value.

Adolescent↗

PubMed1995

Splenectomy before tumor inoculation prolongs the survival time of cachectic mice.

The effects of splenectomy on the development of cachexia, tumor growth and animal survival were studied in tumor-bearing CDF1 mice. Mice were inoculated with two subclones of colon 26 adenocarcinoma, clone 20 (with a potent capacity to induce cachexia) and clone 5 (without such activity), and underwent splenectomy before or after tumor inoculation. Splenectomy significantly prolonged the survival of mice bearing clone 20 when it was performed prior to tumor inoculation, although the progression of cachexia and tumor growth were not affected. The survival rate was higher in splenectomized than it was in nonsplenectomized mice 20-40 days after tumor inoculation. Such effects on survival were not observed, however, in mice splenectomized after inoculation with clone 20 or in mice that underwent splenectomy either before or after inoculation with clone 5. The decrease of peripheral blood lymphocyte count observed in mice bearing clone 20 was magnified when splenectomy was performed before tumor inoculation, but the serum levels of tumor necrosis factor and interleukin-6 were comparable. These results indicate that cancer death from cachexia is not directly attributable to enhanced catabolism. The mechanism by which splenectomy ameliorates the survival of cachectic mice remains to be studied, although several changes observed in the splenectomized mice after inoculation, including decreases in the peripheral blood L3T4+ cells and Lyt-2+ cells on the 9th day and 15th day respectively, and increase in the L3T4+/Lyt-2+ cell ratio on the 15th day suggest the involvement of the modified host's immune response.

Adenocarcinoma↗

PubMed1984

The role of the spleen in tumor bearing host: II. The influence of splenectomy in mice.

The effect of splenectomy on neoplastic outgrowth was examined prior to and after implantation of methylcholanthrene-induced C3H/He murine tumors. Splenectomy performed 12 days before tumor inoculation did not affect the tumor outgrowth, however, both splenectomy and sham operation performed shortly before tumor inoculation resulted in significant tumor facilitation compared with the non-operated group, suggesting that this accelerated tumor was not related to the presence or absence of splenic tissue, but rather to systemically-induced immunosuppression. While splenectomy performed 6, 9, 12 days after tumor inoculation did not alter the tumor growth, splenectomy performed early (3 days) or late stage (20 days) after tumor cell challenge revealed a retarded neoplastic outgrowth, compared with the sham operated group. These results suggest that splenectomy in very early and late stages of tumor-bearing host may be effective for tumor treatment.

Animals↗

PubMed2006

Thrombosis of the splenoportal axis after splenectomy.

BACKGROUND AND AIMS: Thrombosis of the portal system is a potentially life-threatening complication after splenectomy. The reported incidence is low (approximately or = 1%), however may be underestimated due to difficult in making the diagnosis. The factors associated with its development and the clinical outcome are poorly characterized. The aim of this study was to assess the incidence, risk factors, treatment, and outcome in series of consecutive cases. MATERIALS AND METHODS: All patients who had undergone a splenectomy (both open and laparoscopic) between January 1997 and December 2004 at the Department of Surgery of University of Milan Bicocca were retrospectively reviewed. Twelve cases of thrombosis (7.6%) among 158 splenectomies were identified. No significant differences were noted in age, gender, and surgical approach between patients who developed thrombosis and those who did not. Indication for splenectomy in patients with thrombosis were myeloproliferative disorders (n=5), hemolytic disease (n=4), and lymphoproliferative disorder (n=3). All patients had splenomegaly (mean 1.380 kg, range 0.400-3.120 kg). RESULTS: Among patients with myeloproliferative disorders, five (33%) developed the complication, compared with 4 of 35 (11.5%) with hemolytic disease. Patients with both splenic weight >2.500 kg and myeloproliferative disorders had 80% incidence of portal thrombosis. Preoperative prophylactic anticoagulant therapy with low molecular weight heparin was administered in each case. All these patients had fever, abdominal pain, or leukocytosis. All diagnoses were made by contrast-enhanced computed tomography (CT) scan and ecocolordoppler ultrasonography, and anticoagulation therapy was initiated immediately. Treatment within 15 days after splenectomy was successful in all patients, while delayed treatment was ineffective. CONCLUSIONS: Portal thrombosis should be suspected in patients with fever or abdominal pain after splenectomy. Patients with myeloproliferative disorders and hemolytic diseases are at higher risk, as well as patients with marked splenomegaly. A high index of suspicion, early diagnosis, and prompt anticoagulation therapy are the keys to a successful outcome.

Abdominal Pain↗

PubMed2005

Laparoscopic splenectomy in the elderly: a morbid procedure?

BACKGROUND: Laparoscopic splenectomy has emerged as the gold standard for elective splenectomy. Few reports have critically evaluated the results of laparoscopic splenectomy in elderly patients. METHODS: All laparoscopic splenectomies performed between August 19, 1998 and June 8, 2004 were reviewed retrospectively. RESULTS: Of 235 splenectomies, 188 were performed for patients younger than age 65 years (group 1), and 45 were performed for patients 65 years of age or older (group 2). The groups were demographically similar, except for the average age and the American Society of Anesthesiology (ASA) classification. Operative characteristics were similar, but the average length of hospital stay differed: 2.2 days for group 1 and 3.9 days for group 2 (p < 0.03). Complications occurred for 8.5% of group 1 and 17.8% of group 2, but the percentages were similar by ASA class. CONCLUSIONS: Elderly patients have a higher rate of complications after laparoscopic splenectomy. The complications are similar when matched for ASA class, but a larger percentage of elderly patients fall into higher ASA class ratings.

Adolescent↗

PubMed2001

Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura.

BACKGROUND: Splenectomy has been shown to produce long term remission in patients with immune thrombocytopenic purpura (ITP). With the development of laparoscopic splenectomy, there is renewed interest in the surgical treatment of ITP. The aim of this study was to identify factors that are predictive of outcome after laparoscopic splenectomy for ITP. METHODS: A case series of 67 consecutive patients with ITP undergoing laparoscopic splenectomy was reviewed. A positive response was defined as a postoperative platelet count greater than 150,000/ml requiring no maintenance medical therapy on follow-up evaluation. A chi-square test and a stepwise logistic regression analysis were performed for the following variables: age, gender, preoperative response to steroids, duration of disease, severity of preoperative bleeding, accessory spleens, and thrombocytosis on discharge. RESULTS: At a median follow-up period of 38 months (range, 2-56 months), 52 patients (78%) had a positive response to laparoscopic splenectomy. Of the 15 patients (22%) who did not have a positive response, 11 were refractory and 4 relapsed. All relapses occurred in patients with a platelet count less than 150,000/microl at discharge. Patient age was the most significant predictive factor for success or failure of the operation. The median age of the responders (31 years; range, 19-71 years) was significantly lower than the median age of the nonresponders (49 years; range, 24-62; p < 0.001). Only 5.6% of those younger than 40 years did not have a positive response, compared with 42% of patients older than 40 years (p < 0.05). Patient age was significantly associated with outcome on univariable chi-square analysis (p = 0.001), and was the only significant factor on multivariable analysis (odds ratio, 2.65; 95% confidence interval, 1.71-4.1). Other significant predictors of outcome on univariable analysis were preoperative response to corticosteroids and platelet count on discharge. CONCLUSIONS: A long-lasting response after splenectomy for ITP is more likely to occur in patients younger than 40 years of age. To avoid the long-term side effects of corticosteroid use, early surgical referral of younger patients with ITP should be considered.

Adult↗

PubMed1999

Splenectomy for idiopathic thrombocytopenic purpura: comparison of laparoscopic and conventional surgery.

BACKGROUND: This study aimed to compare the safety, efficacy, and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP). METHODS: The results from 14 consecutive patients who underwent LS for ITP were reviewed and compared with the results from patients who underwent OS for the same disease. Demographics, concomitant disease on admission, and platelet counts were evaluated, as were details of the surgical procedure, postoperative physiologic status, and hospital stay. RESULTS: Mean operative time was 88.3 min for OS and 146.4 min in LS group (p < 0.05). The conversion rate to open splenectomy was 7.1. Therapeutic response to splenectomy was 92.8% in the LS group and 86.6% in the OS group. Bowel canalization, return to liquid diet, and length of hospital stay were all significantly delayed in the OS group as compared with those who underwent LS (p = 0.01, p = 0.02, p = 0.005, respectively). In the OS group the morbidity rate was 13.3%, whereas in the LS group it was 7.1%. CONCLUSIONS: Laparoscopic splenectomy represents a valid alternative to conventional splenectomy in the treatment of ITP.

Adult↗

PubMed1994

The white blood cell response to splenectomy and bacteraemia.

The aim of this study was to determine the relationship of the white blood cell (WBC) count to bacteraemia, and the risk of bacteraemia after splenectomy. The case series study was carried out at the Vanderbilt University Level I Trauma Center, and included 11,870 consecutive trauma admissions: 258 required a splenectomy (191) or splenorrhaphy (67). Bacteraemia was defined as the presence of a positive blood culture. Statistical analysis included ANOVA, the non-parametric Kruskal-Wallis test and logistical regression. Forty-two (22 per cent) of the splenectomy patients had positive blood cultures, while only six (9 per cent) of the splenorrhaphy patients had positive cultures. For the group of patients requiring a splenectomy, the mean WBC count was higher and more persistent in patients with bacteraemia. Logistical regression demonstrated that the type of surgery does not significantly correlate with bacteraemia after accounting for severity of injury (TRISS). The study conclusions were as follows (1) for the group of patients with bacteraemia after splenectomy, the peak WBC count was higher and more persistent than that which occurred in the group of patients without bacteraemia after splenectomy; (2) the WBC count cannot be used to predict bacteraemia for an individual patient, but a WBC count greater than 20,000 after 10 days should initiate a vigorous search for infection; (3) the severity of injury (and not splenectomy/splenorrhaphy) accounted for the increased risk of bacteraemia in population studied.

Adolescent↗

PubMed1992

Response to Haemophilus influenzae type B conjugate vaccine in children undergoing splenectomy.

Asplenic children are at increased risk for serious infection with polysaccharide encapsulated bacteria including Haemophilus influenzae type b (HIB), Streptococcus pneumoniae, and Neisseria meningitidis. Immunization with polysaccharide vaccines is recommended for children undergoing splenectomy. In 1987 a new more immunogenic HIB vaccine was licensed in the US to replace the pure HIB polysaccharide vaccine that was licensed in 1985. This polysaccharide-conjugate vaccine consists of the HIB polysaccharide linked to a protein carrier, diphtheria toxoid. Therefore, we evaluated the immune response of children undergoing splenectomy to HIB-conjugate vaccine. Thirteen children (7 with Hodgkin's disease, 4 with idiopathic thrombocytopenia, 2 with hereditary spherocytosis) aged 3 to 19 years were immunized with HIB-conjugate vaccine prior to splenectomy and serum was obtained following splenectomy. In addition, 15 healthy control children aged 2 to 14 years were immunized with the pure polysaccharide HIB vaccine for comparison. The patients undergoing splenectomy who received the HIB-conjugate vaccine had a geometric mean IgG anti-HIB antibody concentration of 48,106 ng/mL versus 10,786 ng/mL for the control patients who received the pure polysaccharide vaccine (P = .01). The presumed protective level of antibody is 1,000 ng/mL and all children were well above this concentration. Therefore, we propose that children undergoing splenectomy be immunized with an HIB-conjugate vaccine.

Adolescent↗

PubMed1995

Pediatric laparoscopic splenectomy.

Laparoscopic surgery is becoming widely accepted as an alternative to conventional procedures. It is becoming more and more evident that laparoscopic techniques can be applied successfully to pediatric patients. Advantages of these techniques include less postoperative pain, decreased ileus, fewer pulmonary complications, and shorter hospital stays. Elective splenectomy for hematologic disease or for staging of Hodgkin's lymphoma also appears to be amenable to laparoscopic techniques. This report details 12 consecutive splenectomies successfully performed laparoscopically since July 1993. No case required conversion to laparotomy. Each case was reviewed with respect to operative time, estimated blood loss, identification of accessory spleens, time until full oral intake, analgesia requirements, and length of stay. Factors contributing to morbidity such as ileus, pulmonary complications, and would infections were evaluated. Documentation was also reviewed for late sequelae such as intestinal obstruction and incisional hernias. These patients were compared with 20 consecutively treated patients who underwent open splenectomy in the period immediately preceding the use of laparoscopic splenectomy. Laparoscopic splenectomy, in the authors' experience, is a safe alternative to open splenectomy, has few complications, is cost effective, and has been well accepted by patients and families.

Adolescent↗

PubMed1984

Role of the liver in host defense to pneumococcus following splenectomy.

Splenectomy is associated with increased susceptibility to bacterial infection, and this is thought to be primarily due to a decrease in clearance of bacteria from the blood. The purpose of the present study was to determine if splenectomy could increase susceptibility to pneumococcus type 3, which is cleared primarily by the liver in rats, and if hepatic function is altered by splenectomy. Splenectomy increased the mortality of rats challenged iv with pneumococcus. Heat-killed, 51Cr-labeled pneumococci were rapidly cleared by the liver and splenectomy did not alter the initial clearance rate or the initial hepatic uptake of bacteria. Injection of viable pneumococci showed that blood levels were unchanged at 30 min but were much greater 5 hr after challenge in splenectomized animals. Hepatic uptake of viable pneumococcus was also not changed at 30 min after injection but at 5 hr the number of bacteria in the liver was greater in the splenectomized animals. This suggests an impairment in hepatic bactericidal function. Another contributing factor may have been that the hepatic bactericidal capacity was overwhelmed by the pneumococci which would normally have been killed by the spleen. Lung localization of viable bacteria was increased initially but there was no decrease in pulmonary bactericidal function. Thus, splenectomy increased susceptibility to a bacteria cleared primarily by the liver which was attributed to an impairment of hepatic bactericidal function and/or an inability of the liver to compensate for the loss of splenic function due to a saturation of the bactericidal system.

Animals↗

PubMed1991

Splenectomy in gynecologic oncology: indications, complications, and technique.

Although uncommonly performed in this setting, splenectomy is sometimes indicated in patients with gynecologic malignancies. From January 1970 through March 1989, 45 patients at The University of Texas M.D. Anderson Cancer Center underwent splenectomy during the course of gynecologic laparotomies. All procedures were performed by the gynecology staff and trainees. Twenty-seven patients (60%) had ovarian cancer; endometrial and cervical cancers were present in three patients each. The remaining 11 patients had other diseases. Splenectomy was planned preoperatively in only 9 patients (20%). Thirteen patients (29%) underwent splenectomy because of injury to the spleen. Injury was most commonly due to traction during omentectomy, resulting in capsular laceration. The injury was immediately recognized in 12 patients; 1 patient required reexploration for hemoperitoneum. In 24 patients (53%), splenectomy was performed for tumor reduction. Pathologic examination showed that 11 of 24 patients had capsular involvement by tumor, 7 had parenchymal metastases, and 6 had no direct splenic involvement. Residual tumor following cytoreduction was smaller than 2 cm in 62.5% of patients. Splenectomy is a well-tolerated procedure and the operative approach can be tailored to the clinical situation and distribution of tumor. An attempt should be made to repair splenic injury when tumor involvement is not present.

Adult↗

PubMed1991

Patient awareness of health precautions after splenectomy.

Sepsis after splenectomy is a lifelong risk, and patients who have had splenectomy should be educated about this risk. This study examines patient knowledge after splenectomy. We reviewed hospital records of 118 patients who had splenectomies performed between 1982 and 1988 at New Hanover Memorial Hospital. Twenty-four patients have died since their surgery; one death was suspected to be due to postsplenectomy sepsis. Of the 89 patients alive and eligible for follow-up, we were able to query 63. Only 16% were aware of any health precautions. After prompting, patient awareness improved to 40%. We also surveyed 11 of the 14 surgeons who performed the splenectomies. They indicated that they always discuss with their patients the immunologic consequences of spleen removal and the increased risks of infection, although they do not always recommend pneumococcal vaccine. We conclude that splenectomy patients have a low level of knowledge about postsplenectomy infection risks and precautions. We developed an educational pamphlet to aid the surgeon in patient education.

Awareness↗

PubMed2006

Decrease of type IV collagen and TIMP-1 serum levels after splenectomy in patients with schistosomiasis mansoni.

The role of the spleen in the process of liver fibrosis in schistosomiasis still needs clarification. The aim of this study was to assess the effect of splenectomy on serum levels of two markers of fibrosis, type IV collagen and TIMP-1, in patients with schistosomiasis mansoni. Twenty-four patients with hepatosplenic schistosomiasis mansoni participated in the study. Type IV collagen and TIMP-1 serum levels were measured preoperatively, and after 2 (POD-1) and 60 days (POD-2) of spleen removal. Before splenectomy, both type IV collagen and TIMP-1 serum levels were elevated in the majority of patients. After splenectomy, the levels of type IV collagen showed a significant decrease in relation to the preoperative values both in POD-1 (median pre-splenectomy: 143.7 ng/ml versus 77.01 ng/ml; p=0.04) and POD-2 (103.3 ng/ml; p=0.015). Serum levels of TIMP-1 also showed a significant decrease in relation to the preoperative values both in POD-1 (pre-splenectomy: 585.9 ng/ml versus 196.4 ng/ml; p=0.008) and POD-2 (97.4 ng/ml; p<0.001). There was no difference between POD-1 and POD-2 values for each serum marker. In conclusion, splenectomy in schistosomotic patients was associated with a decrease in serum markers of fibrosis levels, which persisted for at least 60 days. These results suggest that the spleen may play a role in the extra cellular matrix production, and therefore may contribute to liver fibrosis in schistosomiasis mansoni.

Adult↗

PubMed2004

Laparoscopic splenectomy for treatment of splenomegaly.

BACKGROUND: Laparoscopic splenectomy presents an advantage over open splenectomy, resulting in shorter hospital stay, decreased blood loss, and fewer operative and postoperative complications. Splenomegaly has long been considered a contraindication for laparoscopic splenectomy; however, in the hands of an experienced surgeon, this technique can be effectively applied to the treatment of splenomegaly. METHODS: Records for patients undergoing laparoscopic splenectomy for splenomegaly between 2000 and 2003, performed by a single surgeon in three community-based hospitals, were reviewed and demographic, operative, and postoperative data compiled. Preoperative diagnoses included B cell lymphoma, hemolytic anemia, and chronic lymphocytic leukemia. RESULTS: Seven patients underwent laparoscopic and hand-assisted laparoscopic splenectomy for splenomegaly during this time period. Splenic weights ranged from 410 to 3,100 g, and average operative time was 86.6 minutes. Estimated blood loss ranged from 50 to 350 ml; average hospital stay was 4.4 days. Two postoperative complications, ie, postoperative bleeding and superficial wound breakdown, were noted. CONCLUSIONS: Laparoscopic and hand-assisted laparoscopic splenectomy are effective methods for treatment of splenomegaly.

Aged↗

PubMed2006

Radiofrequency-assisted partial splenectomy with a new and simple device.

BACKGROUND: Although partial splenectomy is preferable to total splenectomy for maintaining an immune response, several techniques by which splenic parenchyma were divided in partial splenectomy have been controversial. METHODS: Partial splenectomy using a new and simple device that irradiates radiofrequency combined with saline irrigation was performed successfully for a 19-year-old man with a large splenic cyst. Splenic parenchyma coagulated along the cutting line by the device was divided using an ultrasonic dissector. RESULTS: The surgical field was virtually bloodless during the parenchymal transection. Blood loss during the surgery was 50 mL without transfusion and the other hemostatic procedures and transection time was 10 minutes. The patient's postoperative course was uneventful and he was discharged home with a perfused spleen on postcontrast computed tomography. CONCLUSIONS: The radiofrequency-assisted technique allows partial splenectomy as a safe and virtually bloodless alternative to total splenectomy for selected patients.

Adult↗

PubMed2006

Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion.

BACKGROUND: To investigate the interactions between splenectomy and perioperative transfusion in gastric cancer patients. METHODS: Medical records of 449 gastric cancer patients who had undergone total gastrectomies for curative intent between 1991 and 1995 were reviewed. The influence of splenectomy on tumor recurrence and survival both in the transfused and nontransfused patients were evaluated by univariate and multivariate analysis. RESULTS: The recurrence rate in the splenectomy group was 48.1% as compared with 22.6% in the spleen-preserved group among transfused patients (P=.001); it was 40.7% compared with 26.5% among nontransfused patients (P=.086). There was no significant difference in the mean survival between the splenectomy group and the spleen-preserved group in a subgroup analysis by stage. Multivariate analysis identified splenectomy as an independent risk factor for recurrence but not as a predictor for survival among transfused patients. CONCLUSIONS: Splenectomy does not appear to abrogate the adverse effect of perioperative transfusion on prognosis in gastric cancer patients. Moreover, it may increase postoperative recurrence in transfused patients.

Adenocarcinoma↗

PubMed2004

The relationship between partial splenectomy and peripheral leukocyte count.

BACKGROUND: Partial splenectomy is accepted as a treatment modality for hypersplenism permitting preservation of the spleen functions. Since a prominent leukocytosis is a marked event after total splenectomy, it was the aim of the present study to compare the peripheral white blood cell counts (PWBC) and immune response in mice following partial and total splenectomy. MATERIALS AND METHODS: Four groups of animals were included in the study: mice in which 70% of the spleen was removed, animals that underwent total splenectomy, mice with sham operation, and a group of mice that served as controls. The proliferative response of peripheral blood mononuclear cells, peritoneal cells, and splenocytes was examined using concavalin (Con) A. RESULTS: In distinction from marked leukocytosis observed in mice after total splenectomy, in partially splenectomized mice the PWBC counts did not show any significant increase during a follow-up period of up to 2 months after surgery. The mitogen response of the mononuclear cells to Con A in partially splenectomized mice was similar to that of controls, while in animals after total splenectomy, it was increased in cells from the peripheral blood and decreased in those from the peritoneum. CONCLUSIONS: The results indicate that removal of as much as about 70% of the spleen in mice is sufficient to maintain a normal PWBC count, suggesting a regulatory role of the spleen remnant on the PWBC production. The normal mitogen response of the cells to Con A indicates that the spleen rudiment preserves at least a part of the immune activity of the intact spleen.

Animals↗