Splenectomy in high-risk patients with splenomegaly

Area of Science:

• Surgical Oncology
• Hematology
• Clinical Outcomes Research

Background:

• Splenectomy in patients with massive splenomegaly and hematologic malignancy is associated with significant morbidity and mortality.
• The procedure offers primarily palliative benefits in these high-risk patient populations.

Purpose of the Study:

• To review the perioperative course of high-risk patients undergoing splenectomy for massive splenomegaly.
• To identify factors influencing complications and mortality in this patient group.

Main Methods:

• Retrospective review of 172 splenectomies over 14 years.
• Focus on 39 high-risk patients with splenomegaly, analyzing comorbidities, indications, complications, and mortality.

Main Results:

• 41% of patients experienced major complications, linked to advanced age and longer operative times.
• Intraoperative transfusions correlated with splenic size; splenic artery preligation was associated with reduced blood loss.
• Three perioperative deaths occurred due to sepsis and multi-organ system failure.

Conclusions:

• Massive splenomegaly and comorbidities significantly increase morbidity and mortality following splenectomy.
• Splenic artery preligation is a valuable technique to minimize intraoperative blood loss and facilitate splenectomy in high-risk patients.