Splenectomy in cancer surgery: diminishing indications?

Area of Science:

• Oncology
• Surgical Pathology
• Health Disparities

Background:

• Splenectomy (SPL) is a surgical procedure involving spleen removal.
• Historically, SPL was used for cancer staging/management (ST) and surgical cancer management (SCM).
• A declining trend in SPL performance has been observed globally.

Purpose of the Study:

• To assess the trend of splenectomy (SPL) for surgical cancer management (SCM) and staging/management (ST) in a predominantly African-American population.
• To analyze the frequency of SPL over a 24-year period at a minority-serving institution.

Main Methods:

• Retrospective analysis of all splenectomies (SPL) performed at Howard University Hospital from 1970 to 1993.
• Data collected included indications for SPL (SCM/ST), patient demographics, and time period of procedure.

Main Results:

• Out of 446 SPLs, 69 (15.5%) were for SCM/ST, primarily for solid intra-abdominal cancers (75%) and lymphoma (25%).
• SPL frequency for SCM/ST decreased from 62% in 1970-1979 to 33% in 1980-1989, and 5% in 1990-1993.
• Patients undergoing SPL for SCM/ST were older (71% >40 years) and predominantly male (61%).

Conclusions:

• Splenectomy (SPL) for cancer staging/management (ST) and surgical cancer management (SCM) has markedly declined in the African-American population studied.
• This decline reflects a broader shift in oncologic practices towards less invasive methods.
• Modern cancer treatment emphasizes avoiding unnecessary surgery, minimizing morbidity, preserving organs, and utilizing advanced imaging techniques.