Does concurrent splenectomy at colorectal cancer resection influence survival?

Abstract

Twenty-one patients had a concurrent splenectomy with resection of colorectal cancer between 1970 and 1988. These were matched individually with disease control patients based on age, sex, site of tumor, Dukes stage, tumor differentiation, and date of the operation. Significantly more patients in the splenectomy group (n = 11) developed postoperative infective complications than in the control group (n = 4) (McNemar test: P = 0.03). Five-year overall actuarial survival was 45 percent in the former group and 59 percent in the latter (log rank test: chi-squared = 1.07; P = 0.24). Similarly, five-year disease-free survival in 17 patients with Dukes B and C cancers who had curative resections did not differ between the groups (log rank test: chi-squared = 0.08; P > 0.25). These results suggest that splenectomy with resection of colorectal cancer increases the risk of postoperative sepsis and does not influence long-term survival. The infrequency of concurrent splenectomy at resection of colorectal cancer may not overcome Type II error.

The Value of Splenic Preservation With Distal Pancreatectomy

“…In addition, concurrent splenectomy at the time of colorectal resection has been shown to result in significantly higher infective complications. 2,3 Despite these reports, the effect of splenectomy following distal pancreatectomy has not previously been demonstrated.…”

“…This places complications into 5 categories with the more severe complications being grades III through V. The grading system is as follows: I, requiring oral antibiotics or treatment; II, requiring intravenous treatment; III, requiring operative or radiological intervention; IV, resulting in significant chronic disability; and V, death as a result of the complication. 2 Test and the Fisher exact test were used to compare complications between groups. The Spearman correlation was used to measure the association between continuous data; the Mann-Whitney test was applied to compare continuous data (eg, hospital stay, blood loss, tumor size, and duration of operation) between splenectomy and splenic preservation groups with 2-sided statistical significance defined as PϽ.05.…”

“…Over the past decade the addition of splenectomy to other major upper abdominal organ resection has been associated with increased postoperative morbidity, especially infectious complications, and therefore, whenever possible, splenic preservation is considered the standard of care in patients undergoing gastric or colon resection. [1][2][3] Splenic preservation has been described in conjunction with distal pancreatectomy. [4][5][6] Although proponents of splenic preservation suggest that it confers benefit, little data exist regarding the outcome following splenic-preserving distal pancreatectomy.…”

After the Treatment Phase of Colorectal Cancer Care: Survivorship and Follow-Up

“…primary repair) with splenectomy being reserved for cases involving uncontrollable bleeding [27]. The effect of splenectomy on CRC outcomes following resection remains controversial at the present time [25,28]. On the other hand, the incidence of injury to the small bowel ranges from one to three percent during colonic procedures [29,30].…”

Pankreaslinksresektion

“…Hierbei zeigte sich aber insgesamt ein uneinheitliches Bild, so z. B. für das Magenkarzinom [22,32] oder das Kolonkarzinom [11,51]. In Bezug auf das Pankreaskarzinom wurde der Effekt einer gleichzeitigen Splenektomie in einer großen Studie mit 326 Pankreasresektionen bei Pankreaskarzinom untersucht.…”