[Splenic injury during left nephrectomy for renal cell cancer]

Left radical nephrectomy is the second most common cause of splenic injury during transabdominal oncological surgery in the upper left quadrant of the abdomen. The incidence of iatrogenic splenectomy during left nephrectomy is estimated to be between 4.3% and 13.2%. The spleen may be injured in three ways: traction, application of retractors or directly by the surgeon's instruments. Capsular tears, lacerations, avulsions and subcapsular haematomas are the injuries most frequently encountered.

The aim of this study was to assess frequency of splenic injury and evaluate methods and results of management of splenic injury during left nephrectomy for renal cell carcinoma.

Left radical nephrectomy was performed in 768 consecutive patients for renal cell carcinoma. The mean patient age was 52 years (range 34 to 88 years). The mean tumor size was 58 mm (range 28 to 230 mm). Depending on tumor size or surgeon's preferences transabdominal or retroperitoneal approach was performed.

Of the 768 left nephrectomies 34 (4.4%) resulted in splenic injury. Splenectomy was required in 18 cases (2.3%). Splenic injuries were more common during transperitoneal approach. The incidence of iatrogenic spleen trauma was 7.5% during transperitoneal approach and 0.8% during retroperitoneal approach. Surgical treatment of splenic injury was performed in 41% of all splenic injuries. In 3 cases splenorrhaphy was performed, in 2 cases we used tissue glue, in 11 cases TachoComb was used. In 2 patients autotransplantation of splenic parts was performed.

Splenic injury during left nephrectomy for renal cell carcinoma is an uncommon complication. The use of haemostatic agent seems to be an effective method of treatment of superficial splenic injuries. Proper management of splenic injury enables preservation of this important organ.