Elective splenectomy for hematological diseases: a vanishing indication

Area of Science:

• Hematology
• Surgical Oncology
• Immunology

Background:

• Splenectomy has historically been a key treatment for hematological disorders.
• Evolving medical therapies have altered traditional treatment guidelines for these conditions.
• This study investigates the changing role of splenectomy in managing hematological diseases.

Purpose of the Study:

• To evaluate the declining evidence for splenectomy in hematological indications.
• To identify the reasons and justifications behind this shift in surgical practice.
• To assess trends in splenectomy rates for various hematological conditions.

Main Methods:

• A retrospective analysis of laparoscopic splenectomies for hematological diseases from 2010-2023.
• Patients were categorized into autoimmune hemolytic diseases, lymphomas, myeloproliferative diseases, and other splenic conditions.
• Data collected included annual splenectomy incidence, new case ratios, and surgical outcomes.

Main Results:

• A significant progressive decrease in splenectomy indications was observed, particularly for autoimmune hemolytic diseases (p < 0.001).
• Splenectomy for immune thrombocytopenic purpura dropped to zero, despite increased diagnoses (p < 0.001).
• Indications for lymphoma remained consistent, while myeloproliferative disease-related splenectomies were rare.

Conclusions:

• The study confirms a substantial decline in elective splenectomy for hematological diseases, primarily autoimmune conditions.
• Awareness of this trend is crucial for surgical departments.
• Maintaining surgical expertise in splenectomy is essential for patient safety and effective treatment when indicated.