Laparoscopic splenectomy for hematologic malignancies

Patients with hematologic malignancy (HM) tend to have large spleens. The purpose of this study was to compare the outcomes of laparoscopic splenectomy for patients with HM to those with benign disease (BD).

A review was conducted of a prospectively accumulated database of 64 consecutive, unselected laparoscopic splenectomies performed by two surgeons between March 1992 and August 1997.

Of 14 patients with HM (7 lymphoma, 6 leukemia, 1 myeloid metaplasia), three required conversion to open splenectomy (21%). In the remaining 11 patients, two had postoperation complications (18%), including one death from sepsis (9%). Of 50 patients with BD (36 idiopathic thrombocytopenic purpura [ITP], 5 spherocytosis, 4 hemolytic anemia, and 5 others), three were converted to open surgery (6%). Complications developed in 5 (11%) of the remaining 47 patients. No deaths occurred. All patients who had spleens larger than 27 cm in diameter required conversion. Patients undergoing laparoscopic splenectomy for HM were older (54 +/- 16 years vs. 36 +/- 18 years; p = 0.002), had larger spleens (median 17.0 cm vs. 11.0 cm; p < 0.001), and had lower preoperation hemoglobin levels (113 +/- 30 g/L vs. 132 +/- 23 g/L; p = 0.03) than patients with BD. The HM group required longer operation time (239 +/- 73 min vs. 180 +/- 61 min; p < 0.01), but showed no differences with respect to operation blood loss (median, 100 vs. 165 mL), requirement for transfusion (median, 0.0 vs. 0.0 units), and length of hospital stay (median 3.0 vs. 3.0 days).

Although patients with HM had larger spleens and required longer operation time for laparoscopic splenectomy, surgical outcomes were equivalent. The laparoscopic approach should be preferred, even for patients with HM. The only limitation appears to be splenic size greater than 27 cm.