Laparoscopic Partial Splenectomy for Unknown Primary Cancer: A Stepwise Approach.

Area of Science:

• Minimally invasive surgery
• Surgical oncology
• Organ preservation techniques

Background:

• Laparoscopic partial splenectomy (LPS) is a challenging procedure for focal splenic lesions, balancing hemorrhage risk with the benefits of splenic immunologic function preservation.
• Preserving spleen function is crucial, especially in pediatric and adult patients, making LPS a valuable, albeit risky, option.

Observation:

• A 58-year-old male with cancer of unknown primary (CUP) presented with a focal splenic lesion.
• Serial imaging revealed increased size and PET-avidity of the lesion, suggesting malignancy or a significant inflammatory process.
• The isolated nature of the lesion and CUP history prompted consideration for LPS.

Findings:

• The laparoscopic partial splenectomy (LPS) was performed successfully with controlled vascular access and intermittent inflow occlusion.
• The procedure took 180 minutes with an estimated blood loss of 175 cc, and the patient was discharged on postoperative day 2.
• Final pathology confirmed an Epstein-Barr virus-associated inflammatory pseudotumor, not a malignancy.

Implications:

• Safe LPS necessitates meticulous pre-operative vascular assessment and a stepwise intra-operative approach.
• Minimizing blood loss during LPS involves anatomic transection and intermittent vascular isolation.
• Further research is needed to explore the potential immunological and oncologic benefits of LPS in cancer of unknown primary patients.