Splenectomy for massive splenomegaly

Several groups of authors have recently reported that removal of the massively enlarged spleen (1,500 grams or greater) is associated with a greater morbidity than that encountered in patients with spleens of smaller sizes. In our experience, 46 of 51 patients with massively enlarged spleens had a myeloproliferative disorder (leukemia, lymphoma or agnogenic myeloid metaplasia) and usually had a limited life expectancy. When morbidity in these patients was compared with that in patients with the same diagnosis but spleens of smaller size, no increase in complications or death was found other than a greater operative blood loss in patients with non-Hodgkin's lymphoma. Limitation of operative morbidity in patients with very large spleens depends on careful selection and appropriate operative and perioperative management.