Splenectomy for massive splenomegaly: long-term results and risks for mortality

Area of Science:

• Surgical Oncology
• Hematology
• Gastroenterology

Background:

• Massive splenomegaly (>1500 g) often requires splenectomy for palliation in advanced hematologic malignancies.
• Perioperative complications and long-term survival factors post-splenectomy for massive splenomegaly are not well-defined.

Purpose of the Study:

• To evaluate long-term outcomes and safety of splenectomy for massive splenomegaly.
• To identify predictive factors for survival and assess the achievement of palliative goals.

Main Methods:

• A consecutive series of 222 patients with massive splenomegaly underwent splenectomy between 1998 and 2009.
• Follow-up until death or at least 2 years; linear and logistic regression analyses were used to assess survival predictors.

Main Results:

• Most common indications were non-Hodgkin lymphoma (48%) and myeloid metaplasia (31%). Mean splenic weight was 2731g.
• 30-day mortality was 1.8%, with a 20% complication rate (hemorrhage, portal venous thrombosis).
• 98.5% achieved symptom relief; durable remission of anemia/thrombocytopenia occurred in 50% at 2 years. Preoperative transfusion need predicted decreased survival.

Conclusions:

• Splenectomy for massive splenomegaly is a safe procedure providing durable palliation.
• Preoperative transfusion requirements serve as an indicator of disease severity and a predictor of reduced survival.