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Massive splenomegaly.

H A Johnson1, R A Deterling

  • 1Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts.

Surgery, Gynecology & Obstetrics
|February 1, 1989
PubMed
Summary
This summary is machine-generated.

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.

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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).

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  • 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.