Minimally invasive surgery for splenic malignancies

While minimally invasive surgery, i.e. laparoscopy, has become well-accepted in the treatment algorithm for malignancies of the gastrointestinal tract and gynecologic tumors, the role of laparoscopy for malignancies involving the spleen is less clear. Initially described in 1992 for benign hematologic disease, laparoscopic splenectomy (LS) for splenic malignancy was avoided secondary to the severe hematologic disease, profound cytopenia, and massive splenomegaly frequently seen in these patients. As experience with LS grew and larger data were generated, it became clear that hematologic malignancy and splenomegaly could be safely managed laparoscopically. In experienced hands, LS can be used for the diagnosis and treatment of both lymphoproliferative and myeloproliferative disorders affecting spleen, in addition to splenic tumors of both primary and metastatic origin. LS can be performed from a lateral or anterior approach, and hand-assisted laparoscopic splenectomy can provide significant benefit in cases of massive splenomegaly. Preoperative imaging for accurate splenic measurement is invaluable to guide surgical planning. Triple vaccination should be given to all patients prior to surgery, and splenic artery embolization before surgery should be considered in patients with massive splenomegaly to reduce intraoperative bleeding. LS can be performed safely for nearly all cases of malignancy involving the spleen, and potentially offers significant advantages of decreased pain and recovery time while maintaining equivalent complications and survival compared to open splenectomy.