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PubMed1993

Long-term results in hairy cell leukemia treated by splenectomy.

Splenectomy as a therapeutic modality has been evaluated in a group of 24 consecutive patients. Before and after splenectomy only supportive therapy was applied with the exception of two patients in whom corticosteroids were administered because of vasculitis. Radiation therapy was applied in one patient because of massive retroperitoneal lymphadenopathy. One patient received Leukeran shortly before the fatal outcome because his response to splenectomy was poor. Out of 24 patients 14 patients died. The median survival for the partial responders and non-responders was 6 months only. Patients with a complete response did not reach median survival yet and 8 of them (33% of the whole group) have been alive for more than 9 years, one patient for more than 20 years. Two distinct groups of patients with respect to the outcome of splenectomy can be distinguished: The first group is characterized by a rapid fatal outcome mostly within two years after splenectomy, the second group has a more favorable course with a plateau and only occasional deaths after the fourth year.

Adult↗

PubMed1977

Splenectomy, chemotherapy, and survival in Hodgkin disease.

The question was raised whether routine splenectomy might, by virtue of its effects on the receipt of subsequent chemotherapy, offer long-term benefits to patients with advanced Hodgkin disease. Therefore, we compared followup data from a group of patients who were receiving mechlorethamine hydrochloride, vincristine sulfate, procarbazine hydrochloride, and prednisone (MOPP regimen) and who had had splenectomies to a group of similarly treated, carefully matched control patients on the MOPP regimen who had not had splenectomies. Our results indicate no important difference in duration of survival or long-term remission status. There was only a suggestion that splenectomy in such patients may be followed by impaired resistance to subsequent infections. Therefore, although early splenectomy can be important in the assessment of splenic disease, it must not be considered to be a therapeutic procedure per se.

Dactinomycin↗

PubMed1993

[Splenectomy in childhood. Review of a case load].

We review the cases of splenectomy performed in children between 1974 and 1988. During this period, we performed 24 splenectomy procedures, none of which were done as a result of injury. Most patients were between 5 to 10 years of age and had the splenectomy as a result of hemolytic disease. Antibiotic prophylaxis and anti-pneumococcic vaccination preceded splenectomy, resulting in a low morbidity and mortality. This report emphasizes the indications for splenectomy, a decrease in its frequency, variations in its etiology and the low incidence of surgical complications.

Age Factors↗

PubMed1996

Laparoscopic splenectomy in childhood hematologic disorders.

Laparoscopic splenectomy is a new technique that is being utilized in patients with a variety of mostly hematologic disorders. Its application in children has not been extensively documented. Between January 1994 and February 1995, 11 children less than 15 years of age underwent elective laparoscopic splenectomy. Data collected from this treatment group were compared to that from the ten most recent open splenectomy patients with comparable hematologic disorders. All procedures in both groups were successful in relief of symptoms, increase in platelet count, and/or increase in hematocrit. Operative times averaged 147 mm in the laparoscopic group, compared to 112 mm in the open group. Estimated blood loss was 32 ml in the laparoscopic group and 86 ml in the open group. Days to laparoscopic patient discharge were 3.6, compared to 5.3 days in the open group. There were no wound complications or need for perioperative platelet transfusions in the laparoscopic patients. Patient response has been uniformly positive in the laparoscopic group. Reusable access trocars are utilized for two of the four working ports. Stapling devices and special tissue morselizers are not required. There are no additional operating room or surgeons fees incurred in the laparoscopic procedures. This series demonstrates that laparoscopic splenectomy is a safe, cost-efficient alternative to open splenectomy in children with a variety of hematologic disorders.

Adolescent↗

PubMed1996

Splenectomy for poor graft function after allogeneic bone marrow transplantation in patients with chronic myeloid leukemia.

We report four patients with chronic myeloid leukemia (CML) that showed poor graft function after a non-T-depleted bone marrow transplantation (BMT) from an HLA-compatible sibling donor and who were successfully treated with splenectomy. Conditioning was done with cyclophosphamide (CY) and total body irradiation (TBI) without additional splenic irradiation. Three patients had enlarged spleens before BMT. The nucleated cell dose infused ranged from 2.3-3.2 x 10(8)/kg. Bone marrow (BM) examination prior to splenectomy showed BM aplasia (three cases) or hypocellularity (one case). At splenectomy no patient had evidence of cytomegalovirus (CMV) infection or severe acute GVHD; and three patients had moderately enlarged spleens. All patients were transfusion dependent. Complete hematological recovery was obtained in all patients. BM cellularity was normal 1 month after splenectomy. Complete chimerism of donor origin was documented. The four patients are alive (+16 to +58 months after BMT). Thus, in patients with CML, a poor graft function may be successfully corrected by splenectomy.

Adult↗

PubMed1998

[Laparoscopic splenectomy for a massive splenomegaly using a transcatheter technique].

Laparoscopic splenectomy can be performed more safely today, and therefore it is becoming the first-choice technique for splenectomy when the spleen is of normal size. However, for massive splenomegaly there have been few reports of the use of this technique and its safety has not been confirmed. We performed laparoscopic splenectomy for massive splenomegaly with transarterial embolization of the splenic artery before surgery. A 37-year-old man underwent splenectomy due to the lack of effect of an approximately 4-month course of chemotherapy for chronic myeloid leukemia whose spleen was over 20 cm in length. Before surgery, splenic artery embolization was performed to prevent intraoperative bleeding and to debulk the spleen. Under general anesthesia the patient was positioned in the lateral decubitus position lying on the right side. There was no bleeding from the capsule of the spleen throughout the procedure and no intraoperative complications occurred. Blood loss was 100 ml, and the weight of the resected spleen was 1,100 g. The postoperative course was uneventful. We conclude that laparoscopic splenectomy is safe and feasible in cases of splenomegaly, when combined with preoperative embolization of the splenic artery.

Adult↗

PubMed2000

Laparoscopic splenectomy: a suitable technique for children and adults

Aims: Splenectomy retains an important role in the management of certain haematological conditions that fail to respond to conventional medical therapy, and has traditionally been performed through a midline or left subcostal incision with patients requiring 5-7 days in hospital. The well recognized benefits of laparoscopic surgery should also apply to splenectomy. This study aimed to develop a safe and effective technique suitable for all age ranges and without the requirement for expensive stapling devices. METHODS: An operative technique evolved over the 5-year period from 1994, from an initial six-port approach with the patient supine, to a four-port approach in a modified right lateral position, with locking surgical clips applied down a 5-mm port to vessels in the hilum, and removal of the spleen within a retrieval bag through a 4-6-cm Pfannanstiel incision. Data were collected prospectively for all patients undergoing laparoscopic splenectomy at Leicester Royal Infirmary, including demographic details, indication for surgery, duration of surgery, length of inpatient stay, transfusion requirement, postoperative complications and the response of the original condition to surgical intervention. RESULTS: A total of 40 patients underwent laparoscopic splenectomy (14 children, 26 adults) for a variety of conditions (idiopathic thrombocytopenia (ITP) (n = 24), haemolytic anaemia (n = 9) or malignancy (n = 7)) with a median operating time of 180 min for the first 20 patients and 100 min for the second 20 (P < 0.0001), and median inpatient stay of 3 days for the first 20 patients and 2 days for the second 20 (P < 0.0003). None of the operations was converted to open surgery, five patients required blood and/or platelet transfusion perioperatively, none of the patients had major postoperative complications, 23 of the 24 patients with ITP developed normal platelet counts after operation, and all nine patients with haemolytic anaemia maintained a normal haemoglobin concentration after operation. CONCLUSION: Laparoscopic splenectomy can be performed safely and effectively in adults and children without the need for stapling devices.

Journal Article↗

PubMed2000

Anti-AB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation.

BACKGROUND: A shortage of organ donors for transplantation has become a serious problem throughout the world. To overcome this problem, transplantations across ABO blood barriers have been performed with some success. In general, however, the graft survival rate for transplantation with ABO incompatibility is lower than that of transplantation with ABO compatibility. Unfortunately, the mechanism by which isohemagglutinins might injure an ABO-incompatible graft remains uncertain. Here, the pre- and posttransplantation anti-AB titers in patients who received transplants from ABO-incompatible living donors are reviewed and the pathological findings are compared. METHODS: One hundred and one patients underwent ABO-incompatible living related kidney transplantation (i-LKT) between January 1989 and October 1999 at our hospital. Plasmapheresis and immunoadsorption were performed in all of the i-LKT patients before the transplantation to remove anti-AB antibodies. A splenectomy was also performed during the operation, followed by the local irradiation of the graft with a dose of 150 rad. The anti-AB titers and pathological findings for 93 i-LKT patients, excluding 8 patients who died, were then examined. RESULTS: Immediately after the i-LKT, the anti-AB titer dropped rapidly to below 1:4 in all 93 cases. Seventy of patients (70/93, 75%) showed no elevation in their anti-AB titer during their follow-up. However, the remaining 23 patients (23/93, 25%) showed a significant elevation of their anti-AB titer to over 1:16. Sixteen of these patients (16/93, 17%) exhibited an anti-AB titer of over 1:32. Out of these 16 patients, 11 patients (11/16, 69%) lost their grafts. The anti-AB titer in the remaining five patients (5/16, 31%) spontaneously decreased without any special treatment. Seven patients (7/93, 8%) exhibited an elevated titer of 1:16. Out of these patients, only one patient (1/7, 14%) lost his graft. The elevated titers in the remaining six patients (6/7, 86%) eventually decreased. The graft function improved in patients whose elevated anti-AB titers eventually decreased. Control patients (ABO-compatible kidney transplant patients) showed a normal elevation of their titer values compared with preoperative titers. Pathological findings showed severe humoral rejections in all cases with high anti-AB titers that lost grafts. Humoral rejection was also detected in most of the patients whose anti-AB titer was elevated to over 1:16 after the transplantation, but excellent renal function was resumed once the titers decreased to below 1:4. CONCLUSIONS: In 23 out of 93 i-LKT patients (25%), the anti-AB titers were significantly elevated after the splenectomy. In view of other reports of i-LKT without splenectomy, we feel that a splenectomy in i-LKT patients might be unnecessary. Pathological evidence suggests that the decrease in the anti-AB titer after transplantation might be the net result of plasmapheresis before the operation and the adsorption of antibodies to the endothelium of the transplanted organ after the operation, neither of which is influenced by a splenectomy.

ABO Blood-Group System↗

PubMed1980

Chronic immunologic thrombocytopenic purpura: results of cyclophosphamide therapy before splenectomy.

Corticosteroids, cyclophosphamide, and splenectomy were employed in the treatment of 43 patients with immunologic thrombocytopenic purpura. All received corticosteroids initially; 22 patients received corticosteroids and cyclophosphamide, and six received drug treatment and underwent splenectomy. Of those receiving corticosteroids alone, 11 had excellent responses and ten had good responses. Of those receiving corticosteroids and cyclophosphamide, responses to treatment were excellent in six, good in eight, and fair in two. Of those receiving drug treatment and undergoing splenectomy, the responses to treatment were excellent in four, good in one, and fair in one. The duration required for induction of remission indicated the prognosis for patients; excellent responses were observed at 1, 2.4, and 4 months in groups treated, respectively, with corticosteroids, corticosteroids and cyclophosphamide, and drugs plus splenectomy.

Adolescent↗

PubMed1982

Steroid responsiveness. A predictor of the outcome of splenectomy in children with chronic immune thrombocytopenic purpura.

Splenectomy is curative for many children with chronic immune thrombocytopenic purpura (ITP), but not without placing them at increased risk for serious infections. To determine the reliability of a trial of corticosteroids in predicting the outcome of splenectomy, 36 children with chronic ITP were studied retrospectively. All 20 of the children with a good response to corticosteroids achieved a complete remission after splenectomy, whereas only two of 13 nonresponders exhibited a lasting benefit from surgery. Corticosteroid responsiveness was found to be a highly reliable method of correctly identifying those patients with chronic ITP who would benefit from splenectomy.

Adolescent↗

PubMed1999

Laparoscopic vs open splenectomy.

HYPOTHESIS: Laparoscopic splenectomy (LS) provides health benefits to patients compared with open splenectomy (OS) in terms of perioperative morbidity, complications, and patient recuperation. DESIGN: Prospective operative and outcome data of LS patients were compared with those of OS patients (historical controls). SETTING: Data were gathered, and patients were evaluated and treated at 2 McMaster University teaching hospitals in Hamilton, Ontario, and at the University of Kentucky Chandler Medical Center, Lexington, also a teaching hospital. PATIENTS: From January 1, 1994, through October 31, 1998, a total of 210 patients were studied. Of them, 147 patients from 3 university teaching hospitals underwent LS. These patients were matched with 63 OS patients according to age, sex, spleen weight, indication for splenectomy, and preoperative morbidity score. INTERVENTIONS: A total of 147 patients evaluated for elective splenectomy underwent LS. MAIN OUTCOME MEASURES: Spleen weight, operative time, intraoperative blood loss, postoperative hospital stay, perioperative complications, and cost. RESULTS: No significant difference in mean spleen weight was found between groups. Mean operative time was significantly longer for LS, but intraoperative blood loss was significantly lower. Mean postoperative hospital stay was significantly lower and perioperative complications significantly fewer for LS patients. Mean cost for LS with no complications was slightly lower than for OS. CONCLUSIONS: Compared with OS, the lateral approach to LS takes longer to perform but results in reduced blood loss, shorter postoperative stay, and fewer complications. Mean weighted cost of LS is lower than OS at the study institutions. A prospective, randomized, controlled trial comparing these techniques is planned.

Adolescent↗

PubMed2004

Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura.

HYPOTHESIS: Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). DESIGN: Case series. SETTING: Private, tertiary care referral center. PATIENTS: Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001. INTERVENTIONS: Laparoscopic splenectomy. MAIN OUTCOME MEASURES: A successful response to LS was defined as a postoperative platelet count greater than 100 x 10(3)/microL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 10(3)/microL without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 10(3)/microL, but thrombocytopenia subsequently recurred. RESULTS: Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P =.005) and had a higher preoperative platelet count (P =.005). In multivariate analysis, younger age (P =.005) and a higher preoperative platelet count (P =.007) again predicted a successful response to LS. CONCLUSIONS: A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10(3)/microL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.

Adult↗

PubMed1980

Regeneration of the spleen after ectopic implantation and partial splenectomy.

Overwhelming postsplenectomy infection is a well-defined clinical entity resulting from the inability of the splenectomized host to combat infections with encapsulated bacteria. Because of this lethal complication, a number of alternatives to splenectomy have been studied, including autotransplantation of the removed spleen or partial splenectomy. The ability of the splenic tissue to regenerate depends on the type of procedure selected. In this study, the regenerating capacity of the splenic tissue is studied in 99 Sprague-Dawley rats. These animals were subjected to surgical autotransplantation and partial splenectomy. Our results demonstrated the superiority of partial splenectomy over autotransplantation in terms of regeneration of the splenic mass.

Animals↗

PubMed1983

Splenectomy and death in renal transplant patients.

To determine any association of splenectomy and death, 191 recipients of a single renal transplant were reviewed. Pretransplant splenectomy was performed in 90(47%) patients and the spleen was retained ("spleen-retaining") in 101 (53%). Sixty-eight patients (36%) died. Thirty-two fatal infections occurred in asplenic patients compared with ten infection-caused deaths in those retaining the spleen; 12 asplenic and 14 spleen-retaining patients died of noninfectious causes. Age, sex, graft source, HLA mismatch, and period of graft function were similar in asplenic and spleen-retaining patients who died. Prospective, multicenter, and single-center studies support divergent conclusions regarding the risks and benefits of splenectomy in transplantation. Study of specific center experience should precede adopting a policy of pretransplant splenectomy, an irreversible form of immunosuppression significantly related to fatal infection.

Adult↗

PubMed1988

Splenectomy for thrombocytopenia due to secondary hypersplenism.

The response to splenectomy of patients with thrombocytopenia due to secondary hypersplenism is frequently unpredictable. Our experience indicated that splenectomy is seldom justified for this indication in patients with chronic myelogenous or chronic granulocytic leukemia. Since patients with chronic lymphocytic leukemia, hairy-cell leukemia, and stage IV lymphoma may have a more prolonged life expectancy, removal of the spleen brings about a satisfactory response of thrombocytopenia in some instances. Elevation of platelet counts after splenectomy in patients with agnogenic myeloid metaplasia is most likely to occur in women with the primary form of the disease. In other nonmalignant conditions, splenectomy has resulted in a satisfactory response in the majority of patients.

Adult↗

PubMed1988

Splenectomy and the induction of murine colon cancer.

The influence of a functional spleen on induction and growth of cancer is unknown. Both beneficial and detrimental results have been observed in tumor-bearing hosts following splenectomy. We examined the effect of splenectomy, splenic autotransplantation, and splenic preservation on the induction and growth of 1,2-dimethylhydrazine (DMH)-induced murine colon cancer. Following splenectomy there was a significant increase in malignant tumors but no increase in benign tumors. To rule out the possibility that splenectomy increased the carcinogenicity of DMH by decreasing the capacity for DNA repair in colon cells, the units of 06-alkylguanine DNA alkyltransferase were measured in tumor-free and malignant colon tissue from both splenectomized and control rats. This repair protein was chosen because it is known to protect cells from the mutagenic effects of methylating agents. There was no significant difference in the alkyltransferase activity of tumor-free colon vs malignant tumor or between treatment regimens. Thus, the ability of the spleen to protect rats from the induction of malignant colon tumors induced by DMH is most likely due to preservation of immunologic surveillance in the host.

Adenocarcinoma↗

PubMed1997

Is pediatric laparoscopic splenectomy safe and cost-effective?

OBJECTIVE: To determine whether laparoscopic splenectomy (LS) is a safe, cost-effective alternative to open splenectomy (OS). DESIGN: Retrospective comparison and economic evaluation. SETTING: Tertiary care children's hospital. PATIENTS: Children with hematologic disease involving the spleen. INTERVENTIONS: Laparoscopic splenectomy (10 patients); OS (10 patients). MAIN OUTCOME MEASURES: Safety of LS and cost differential between LS and OS. RESULTS: Operative time was longer for LS. Discharge occurred 64 hours postoperatively for LS and 79 hours for OS (P < .03). Patients who underwent LS returned to activity 1 to 5 weeks faster than patients who underwent OS. The average (+/-SD) operative charges for LS was $7176 +/- $2064 and for OS, $1977 +/- $344 (P < .001). Total hospital charges averaged $13,033 +/- $2976 for LS and $7106 +/- $1923 for OS (P < .001). CONCLUSIONS: Laparoscopic splenectomy can be performed safely in children. In our hospital, LS is more expensive than OS. The faster return to school and normal activity warrants the continued use of this procedure despite the increased cost.

Adolescent↗

PubMed1996

Priapism following splenectomy in an unstable hemoglobin: hemoglobin Olmsted beta 141 (H19) Leu-->Arg.

We report a case of severe priapism occurring in a patient with an unstable hemoglobin, Hb Olmsted (beta 141 Leu-->Arg) This is a rare hemoglobin variant, which until now has been reported only once. The clinical course of the 12-year-old boy was characterized by severe hemolytic anemia leading to splenectomy and cholecystectomy at the of 3.5 years. The priapism occurred 8 years after splenectomy, during a hemolytic febrile episode and required aspiration of the corpora cavernosa. This report raises the question of the benefit of splenectomy in patients suffering from a chronic hemolytic anemia such as that due to an unstable hemoglobin. This treatment lowers the frequency and the severity of acute hemolytic attacks, but several cases of vascular complications have been reported after splenectomy.

Anemia, Hemolytic↗