Splenectomy for Hematologic Disorders

Schwartz, Seymour I.

doi:10.1001/archsurg.1970.01340260242036

Cited by 55 publications

(17 citation statements)

References 32 publications

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“…Some authorities have recommended the operation for every patient immediately after diagnosis of AMM [6], others, for selected patients [3][4][5]8,9,15], and still other authors consider splenectomy as a palliative procedure to be used only in exceptional cases [ a very tentative and uncertain estimate of the expected benefits of splenectomy in AMM in terms of symptom relief and survival. Mortality and morbidity after splenectomy in AMM have been repeatedly found to be higher than those after splenectomy for other hematological disorders [ 1,2,4,11,12]. The average operative mortality after splenectomy in AMM was 13.4%, and serious early morbidity occurred in 45.3% of the patients.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

“…None of them met all accepted methodologic requirements (Table I). Data on the duration of follow-up were provided in nine studies [1][2][3][4]6,8,10,13,15]; on late surgical morbidity, in four [8,9,13,15], and on the median survival, in three [6,10,13]. Defined criteria were used to evaluate the benefit of splenectomy in seven studies [3,8,[10][11][12][13]151.…”

Section: Literature Reviewmentioning

confidence: 99%

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The choice between splenectomy and medical treatment in patients with advanced agnogenic myeloid metaplasia

J¹,

Gilon²,

Penchas³

1990

American J Hematol

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The objective of the study was to explore the risks and benefits of splenectomy in advanced agnogenic myeloid metaplasia (AMM). We searched the literature (Medline, 1970-1987) for studies of postoperative survival, operative mortality and effects of splenectomy on painful splenomegaly, and portal hypertension or transfusion requirements in patients with AMM. We employed formal decision analysis to determine the relative value of medical and surgical treatment of advanced AMM. Results of data synthesis showed that splenectomy in AMM is associated with an operative mortality of 13.4% (95% confidence intervals (CI): 9.5-17.2%), an early morbidity of 45.3% (CI: 39.6-51.1%), and a late morbidity of 16.3% (CI: 9.9-22.5%). Almost all patients with portal hypertension and painful splenomegaly, but only about half of those with thrombopenia and anemia were reported to have experienced relief in their symptoms or signs after splenectomy. We found no evidence that splenectomy affects survival in AMM. We concluded that splenectomy in advanced AMM is a palliative procedure that carries a substantial risk. It may be considered for symptomatic patients after they have been informed about the operative mortality, morbidity, and chances of palliation. Decisions about treatment of advanced AMM should be guided predominantly by the patient's preferences.

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Section: Conclusion and Recommendationsmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

The choice between splenectomy and medical treatment in patients with advanced agnogenic myeloid metaplasia

J¹,

Gilon²,

Penchas³

1990

American J Hematol

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“…About 15% of IM pa tients develop portal hypertension or other forms of clinically prominent liver dysfunction secondary to myeloid metaplasia in the course of the disease [3]. However, it has been pointed out that this proportion increases markedly following splenectomy [5][6][7], a procedure that can be useful in those IM patients with painful splenomegaly or pancytopenia secondary to hypersplenism [2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Whereas infection and bleed ing are the most frequent and well-known complica tions of splenectomy in IM, information on the he patic abnormalities that subsequently develop in such patients is scarce [19].…”

Section: Introductionmentioning

confidence: 99%

Liver Dysfunction following Splenectomy in Idiopathic Myelofibrosis: A Study of 10 Patients

López‐Guillermo¹,

Cervantes²,

Bruguera

et al. 1991

Acta Haematol

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The hepatic abnormalities that developed after the splenectomy in 10 subjects with idiopathic myelofibrosis were analyzed. In all patients in whom a liver biopsy was performed during the splenectomy, ex-tramedullary hematopoiesis was demonstrated, consisting of dysmorphic megakaryocytes primarily localized in the sinusoids, often accompanied by erythroid precursors. Following splenectomy, a significant increase in both the liver size and serum levels of alkaline phosphatase, bilirubin or γ-glutamyl transpeptidase was found within 6 months, whereas no such increase was observed in the serum aspartate transaminase and alanine transaminase concentrations. In addition, 2 patients developed acute liver failure leading to death at 3 and 4 weeks from splenectomy, respectively. In contrast with these findings, no hepatic alterations were observed in 10 chronic myeloid leukemia patients who were also submitted to splenectomy.

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“…The accumulation of lipids in the spleen make it fragile, but spontaneous splenic rupture is still very unusual. We found only four other such cases described, [9][10][11][12] all of which occurred in adults, the oldest being 53 years old. Our patient is the fi rst to be reported from China.…”

Section: Discussionmentioning

confidence: 89%

Niemann-Pick disease resulting in spontaneous splenic rupture in an adult: Report of a case

Chen

et al. 2008

Surg Today

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Niemann-Pick disease (NPD) is an inherited metabolic disorder, which has been classifi ed into types A, B, C, and D. Niemann-Pick disease rarely causes spontaneous splenic rupture: to our knowledge, only four such cases have ever been reported. We report the case of a 53-year-old man with NPD manifesting as spontaneous splenic rupture. Ultrasound showed a ruptured large spleen with hemoperitoneum, and he underwent emergency splenectomy. Histopathological examination confi rmed that there were numerous accumulated "Pick cells," defi ned as foamy histiocytes, in the spleen.

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Splenectomy for Hematologic Disorders

Cited by 55 publications

References 32 publications

The choice between splenectomy and medical treatment in patients with advanced agnogenic myeloid metaplasia

The choice between splenectomy and medical treatment in patients with advanced agnogenic myeloid metaplasia

Liver Dysfunction following Splenectomy in Idiopathic Myelofibrosis: A Study of 10 Patients

Niemann-Pick disease resulting in spontaneous splenic rupture in an adult: Report of a case

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