Splenectomy in the chronic myeloproliferative syndromes. A retrospective risk-versus-benefit analysis

The effect of splenectomy on the course of the chronic myeloproliferative syndromes was retrospectively analysed and compared in 96 patients who underwent this procedure and 195 who did not. The operation had a 4% mortality and a 47% morbidity rate, mainly attributable to haemorrhage, infection and respiratory complications. While splenectomy conferred benefit in certain selected cases with hypersplenism, there was no significant overall improvement in the postoperative haematological values and no influence on the rate of blastic transformation. Splenectomy did not improve survival in the group as a whole, or in any subset (P greater than 0.5). In the non-splenectomy group, only a minority of patients experienced massive progressive splenomegaly and in most individuals the spleen size varied little from the time of presentation to death. Splenectomy in patients with the chronic myeloproliferative syndrome carries a significant mortality and has a high morbidity, does not reduce the rate of blastic transformation and has no influence on survival. The majority of patients on conventional therapy do not experience the discomfort of massive splenomegaly during the course of their disease and the routine use of this operation is inappropriate.