Postoperative complications and prognosis after splenectomy during cytoreductive surgery and hyperthermic...

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for peritoneal metastases (PM) of various origins. The spleen is frequently involved in advanced disease, making splenectomy a common procedure in CRS. This study aimed to evaluate postoperative complications and prognosis associated with splenectomy during CRS + HIPEC.

Data from patients undergoing CRS + HIPEC from 2012 to 2022 were retrospectively collected from a prospectively maintained HIPEC registry. Postoperative complications according to Clavien-Dindo, overall survival (OS), and disease-free survival (DFS) were compared between patients undergoing splenectomy (n = 109) and the control group without splenectomy (n = 282). Cox proportional hazards models were used to identify independent prognostic factors.

The splenectomy group had significantly higher PCI (median 25 vs. 8, p < 0.001) and more frequent diaphragmatic peritonectomy (83% vs. 70%, p < 0.001). High PCI was an independent predictor for splenectomy (adjusted OR 1.18, 95% CI 1.12-1.24). In univariable analysis, the likelihood of severe postoperative complications (Clavien-Dindo grade 3-4) was higher after splenectomy (OR 1.77, 95% CI 1.12-2.80), with increased rates of sepsis and kidney failure. In multivariable analysis, diaphragmatic resection (adjusted OR 4.81, 95% CI 1.99-11.61) was associated with severe complications, whereas splenectomy was not. Splenectomy was also not a predictor of OS and DFS after multivariable adjustment. In contrast, PCI ≥20 and synchronous liver resection were associated with worse OS.

The need for splenectomy during CRS + HIPEC reflects more advanced peritoneal disease; however, splenectomy is not an independent risk factor for postoperative complications. Likewise, it does not independently affect overall or disease-free survival.