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Brant Heniford, Brent Matthews, Charles Backus, Geoffrey Answini, R. Walsh
Abstract:
Introduction: A variety of malignant diseases involving the spleen, both primary and metastastic, may require splenectomy for diagnostic or therapeutic reasons. The role of minimally invasive surgery in the management of malignant diseases involving the spleen is not well defined due to a lack of reported experience with laparoscopic splenectomy (LS) in this group. The purpose of this study is to determine the safety and efficacy of LS for malignant hematologic diseases (MHD). Materials and Methods: Retrospective review of all laparoscopic splenectomies was performed for MHD using a lateral approach or a hand-assisted device when preoperative imaging demonstrated a spleen that was greater than 19 cm in width and greater than 23 cm in cranio-caudal length. Results: Over a 3 year period, we have performed 27 laparoscopic splenectomies for MHD. There were 17 males and 10 females with a mean age was 58.2 years (32-80 years). Thirteen (48.1%) patients had previous abdominal surgery. Nineteen patients had preoperative radiographic imaging and the mean splenic length was 19.1 cm (11-28 cm). The mean morcellated splenic weight was 923.2 gm (250-4750 gm). None of the laparoscopic splenectomies were converted to open. Blood loss averaged 135.4 cc (<30-800 cc). Twelve (45.8%) patients had accessory spleens resected. One patient received a perioperative blood transfusion. This patient had a preoperative hemoglobin level of 9.3 mg/dl. The only postoperative morbidity was a single patient who developed chemical pancreatitis. She was discharged on the second postoperative day. There were no mortalities. The mean length of stay was 2.1 days (1-6 days). All patients staying longer than 3 days did so to facilitate further work-up their MHD. Conclusions: A reluctance to perform LS in patients with MHD may be explained by the technical and oncologic challenges that accompany myeloproliferative and lymphoproliferative diseases such as splenomegaly, perisplenitis, hilar lymphadenopathy and a fear of splenic disruption and tumor spillage. In our experience, LS can be safely performed for MHD even for spleens that were 28 cm in length and greater than 4.7 kg in morcellated weight.
Associated Presentation(s):