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Massive splenomegaly
1Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts.
Surgery, Gynecology & Obstetrics
|February 1, 1989
Summary
Splenectomy for massive spleens (over 1,000g) carries high risks, including infection and sepsis, leading to significant morbidity and mortality. Elective splenectomy for smaller spleens is much safer.
Area of Science:
- Abdominal Surgery
- Hematology
- Surgical Pathology
Background:
- Massive splenomegaly, defined by splenic weights over 1,000 grams, presents unique surgical challenges.
- Myeloproliferative disorders are the primary cause of massive splenomegaly, often necessitating splenectomy.
- Pancytopenia and hemolytic complications are frequent indications for surgical intervention in these patients.
Purpose of the Study:
- To evaluate the morbidity and mortality associated with splenectomy in patients with massive spleens.
- To compare outcomes between patients with massive splenomegaly and those undergoing elective splenectomy for smaller spleens.
- To identify predictors of long-term survival following splenectomy for massive splenomegaly.
Main Methods:
- A retrospective review of 391 splenectomies over 16 years, focusing on 36 patients with massive spleens (>1,000g).
- Analysis of patient demographics, indications for surgery, preoperative conditions (e.g., coagulopathy), surgical techniques, postoperative complications, and survival data.
- Comparison of complication rates and mortality between massive splenomegaly cases and elective splenectomies for smaller spleens.
Main Results:
- Patients with massive spleens experienced significant morbidity (11/36 complications, primarily infection-related) and a 30-day mortality rate of 11.1%, with sepsis as the leading cause.
- Preoperative coagulopathy requiring extensive blood products and failure to achieve hematologic response predicted decreased survival.
- In contrast, elective splenectomy for smaller spleens had minimal morbidity (3%) and no operative mortality.
Conclusions:
- Splenectomy for massive splenomegaly is associated with substantial risks, including high rates of infection and mortality.
- Predictors of poor long-term survival include preoperative coagulopathy, lack of hematologic response, and need for reoperation.
- Elective splenectomy for non-massive spleens offers a much safer alternative with significantly lower morbidity and mortality.