Surgery for massive splenomegaly

Abstract

BackgroundSplenectomy for massive splenomegaly (spleen weight more than 1·5 kg) is commonly believed to be hazardous and to provide poor palliation. The aim of this cohort study was to investigate these issues and examine the many definitions of massive splenomegaly to see whether a better tool might be proposed for preoperative evaluation of these patients.MethodsMorbidity and long‐term outcomes were assessed in consecutive patients. Relief of pressure–volume‐related symptoms and sustainable independence from transfusion in patients were used to ascertain the impact of splenectomy.ResultsSplenectomy was performed in 56 patients, mainly for non‐Hodgkin's lymphoma and myeloproliferative diseases. Median spleen weight was 2·3 (range 1·5–6·0) kg. Mortality at 180 days was zero, and the postoperative complication rate was 25 per cent (17 complications in 14 patients). At 2 years, relief of pain was maintained in 33 of 34 patients, with sustained independence from transfusion in 15 of 19 patients with anaemia and nine of 11 with thrombocytopenia. Spleen weight correlated negatively with BMI (P = 0·036).ConclusionSplenectomy for massive splenomegaly is safe and provides effective palliation. Provisional cut‐off points relating to spleen size and BMI help to identify patients benefiting from a splenectomy, even those in a critical state.

Outcomes of Laparoscopic Splenectomy for Treatment of Splenomegaly: A Systematic Review and Meta‐analysis

“…The laparoscopic approach is considered the gold standard surgical technique for diseases requiring removal of the spleen [1, 2]. Since the first laparoscopic splenectomy (LS) was performed by Delaitre et al [3] in 1991, laparoscopy has proven to be especially useful for surgical treatment of diseases associated with a normal‐sized or slightly enlarged spleen, but some diseases requiring splenectomy are associated with a marked increase in the organ's volume.…”

Elective splenectomy in patients with non-Hodgkin lymphoma: Does the size of the spleen affect surgical outcomes?

“…One patient in group 1 died of hospital-acquired pneumonia. Results from the study of Lemaire et al [ 11 ] seem to confirm good outcomes after excision of massive spleen. However, their series included patients with a more heterogeneous spectrum of underlying hematological conditions.…”

“…This is because the organ is congested and fragile. It often adheres to surrounding tissues, making it difficult to mobilize [ 11 ]. Moreover, the presence of lymphadenopathy and/or parenchymal nodularity or hypertrophy at the hilum might result in a narrow access to the splenic artery and vein, thus increasing the risk of inadvertent iatrogenic vascular injury [ 12 , 13 ].…”

“…Such conditions become even more relevant if a laparoscopic approach is chosen as spleen mobilization and vascular control can be limited by the small room inside the peritoneal cavity. In most published series, the spleen is described as “giant” or “massive” based on its weight [ 11 , 14 - 16 ], while a few reports make such definitions based on its size [ 13 , 17 ]. Moreover, cut-off measurements to make such definitions vary greatly among authors.…”

Percutaneous Microwave Ablation versus Partial Splenic Embolization for Treatment of Hypersplenism in Patients with Liver Cirrhosis

“…Due to the low platelets count , patients develop bleeding manifestations of skin and mucous membranes and reduction in red blood cells causing anemia which in turn leads to lack of oxygen and disturbance of daily activities as well as neutropenia lead to increased vulnerability for the infections which may be very severe and fatal. So hypersplenism with recurrent spontaneous bleeding, frequent blood transfusion or severe recurrent infection is a clinical indication for therapeutic intervention [6].…”