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PubMed1999

Portal, mesenteric, and splenic vein thromboses after splenectomy in a patient with chronic myeloid leukemia variant with thrombocythemic onset.

Portal, mesenteric, or splenic vein thrombosis is a very uncommon complication with significant mortality in the patients undergoing splenectomy for hematologic disorders. We report a 49-year-old woman who developed portal, superior mesenteric, and splenic vein thromboses after splenectomy. Four years before the event, she presented with a marked thrombocytosis and was diagnosed to have chronic myeloid leukemia variant with thrombocythemic onset as evidence by Philadelphia (Ph1) chromosome and a b3a2 BCR/ABL transcript. Six weeks after splenectomy, she developed severe epigastric pain. The diagnosis of thromboses of portal, mesenteric, and splenic veins was made by computed tomography scan and Doppler sonogram. She was successfully treated with antegrade intraarterial urokinase therapy via superior mesenteric artery and long-term anticoagulant therapies. To our knowledge, our patient is the first case of portal, mesenteric, and splenic vein thromboses after splenectomy in a patient with CML variant with thrombocythemic onset successfully treated with antegrade intraarterial thrombolytic therapy followed by anticoagulant therapies.

Female↗
PubMed1996

Risk of cancer following splenectomy.

Only 2 small population-based studies have previously evaluated cancer risk in splenectomized patients. Our objective was thus to investigate cancer incidence following splenectomy for external trauma or for surgical treatment of non-malignant conditions of adjacent organs. Using the unique personal identification number assigned to each Swedish resident, we linked centralized hospitalization records with nationwide total population and cancer incidence data. We excluded cancers diagnosed within the first 12 months after splenectomy and computed standardized incidence ratios for 1,295 patients (contributing 14,390 person-years) splenectormized for external trauma and for 985 patients (contributing 8,91 1 person-years) whose splenectomy accompanied surgical treatment of non-malignant conditions of adjacent organs (mostly peptic ulcers), using age-, sex- and period-specific rates for cancer incidence derived from the entire Swedish population. Patients undergoing splenectomy for external trauma had no significant excess of total or site-specific cancers. Individuals splenectormized in conjunction with surgery for non-malignant conditions of adjacent organs had a non-significant 40% elevated risk of total cancer, with significant increases of lung and ovarian cancers. The excesses of lung and ovarian cancers may be due to chance, but we could not exclude the conditions for which the surgery was performed, other treatments or common predisposing factors (such as cigarette smoking, which has been linked with both peptic ulcer and lung cancer).

Adult↗
PubMed1975

The influence of splenectomy on the invitro lymphocyte response to phytohemagglutinin and pokeweed mitogen in Hodgkin's disease.

Using tissue culture techniques, the 14C-thymidine incorporation of peripheral lymphocytes in 17 Hodgkin's patients was tested before and after splenectomy under stimulation with phytohemagglutinin and pokeweed. Incorporation under phytohemagglutinin stimulation about 10 days after splenectomy was not affected in Hodgkin's patients with pathologic Stages I and II, but was significantly (p less than 0.005) increased in those with Stages III and IV. The total PHA stimulation potency, i.e. the product of the lymphocyte count and PHA stimulation, increased slightly in both groups. Incorporation under pokeweed stimulation after splenectomy did not significantly differ from that before the operation in the two groups. Although the number of cases studied is rather small, it is concluded that splenectomy causes no demonstrable untoward effect on the cellular immunologic potency. The immunologic state is more likely to be favorably influenced than unfavorably.

Adolescent↗
PubMed1981

Splenectomy in hairy cell leukemia: a retrospective multicenter analysis.

To study the effect of splenectomy in hairy cell leukemia, we initiated a retrospective multicenter analysis. A series of 391 patients, contributed by 22 centers (median: 15 cases per center, range 2--130), was analyzed. Since comparison of the data from these centers showed few significant differences, the data were pooled. Factors that proved to have prognostic value at the time of diagnosis was significantly longer in the splenectomy group (n = 225) than in the nonsplenectomy group (n = 166) (P less than 0.0001). When subgroups were analyzed, no difference in survival time was found between splenectomized and splenectomized patients having an age greater than 60 years, symptoms greater than 12 months, spleens less than 4 cm under costal margin, hemoglobin levels greater than 12 g/dl, neutrophils greater than 500/mm3, or platelets greater than 100,000/mm3. After the operation, the platelet count usually increased to acceptable values, whereas the neutrophil count increased less often. Patients with Hb greater than 11 g/dl, neutrophils greater than 1,000/mm3, and platelets greater than 100,000/mm3 after splenectomy, survived longer than patients with a less complete response to the operation (P less than 0.01). In patients with definite splenomegaly and pancytopenia, splenectomy seems to be beneficial. However, in patients without distinctly enlarged spleens, other therapeutical modalities should be considered.

Adult↗
PubMed1982

Canine osteogenic sarcoma treated by amputation and MER: an adverse effect of splenectomy on survival.

Canine and human osteogenic sarcomas, like most other malignant tumors, cause or are associated with progressive impairment of host immune reactivity. Adjuvant immunotherapy with live BCG had shown increased survival in one study of canine disease. Experiments with induced fibrosarcomas in mice had suggested that some of the host immune defect might be ameliorated by splenectomy. A prospective clinical trial was conducted with several cooperating veterinary centers. Dogs with osteosarcoma apparently confined to a limb were randomized to be treated by amputation and methanol-extracted residue of BCG (MER), or by the same modalities plus splenectomy. Randomization was discontinued relatively early in the study because of higher mortality in the splenectomy group. Animals treated by amputation and MER could be compared only with historic controls; median and one-year survival rates did not differ significantly from those of prior series. Animals treated by amputation, splenectomy, and MER had significantly poorer survival.

Amputation, Surgical↗
PubMed1987

Splenectomy during chronic lymphocytic leukemia.

The combination of discontinuous high-dose chlorambucil therapy with splenectomy greatly increased the prognosis of aggressive forms of chronic lymphocytic leukemia (CLL). The median survival for 43 patients was 84 months from diagnosis and 48 months from splenectomy. For 15 stages O, according to Rai classification, obtained after splenectomy, duration ranged from 3 to 105 months. The median survival of a group of patients showing "nodular splenic infiltration" was 104 months and superior to that of a group of patients showing "diffuse splenic infiltration" (72 months). In four of 15 cases studied, the peripheral blood lymphocytic clone disappeared after splenectomy.

Adult↗
PubMed1993

Role of early splenectomy in malignant lymphomas with prominent splenic involvement (primary lymphomas of the spleen). A study of 59 cases.

The outcomes were analyzed retrospectively of 59 cases of non-Hodgkin lymphoma (NHL) that included prominent splenic involvement (LPS). Forty-three patients had low-grade NHL, and 16 had intermediate or high-grade NHL. Forty of the 59 patients underwent splenectomy. Four patients died postoperatively before any treatment, and 10 others received no chemotherapy or radiation therapy. Twenty-nine splenectomized and 16 patients whose spleens were not removed received chemotherapy or radiation therapy. One or more cytopenias were present in 45 patients (77%). Five (18%) of the 28 patients who initially were cytopenic underwent splenectomies that did not correct their blood disorders. The median actuarial survival was 108 months in splenectomized patients and 24 months in those not treated surgically (P = 0.0001). For the 40 splenectomized patients, a normal postoperative platelet count, an initial hemoglobin level of 110 g/l or more, and a postoperative hemoglobin level 110 g/l or more were associated with prolonged survival. These results suggest that cytopenias are frequent in LPS and that their reversal is observed after early splenectomy in 82% of cases. The absence of cytopenia after early splenectomy is associated with prolonged survival.

Actuarial Analysis↗
PubMed1977

Mesenteric venous thrombosis occurring late after splenectomy.

Two patients with mesenteric venous thrombosis which occurred late after splenectomy are reported. In the first case the thrombosis was seen, with preceding thrombocytosis, 3 years after splenectomy. In the second case the thrombosis occurred 2 years and 5 months postoperatively. Platelet counts had not been obtained before the mesenteric thrombosis in this case. In both instances persistent severe anaemia for several weeks preceded the symptoms and signs of mesenteric venous thrombosis. Both patients were treated by extended resection of the affected small bowel. Thus, dangerous thrombocytosis may occur in the presence of persistent severe anaemia even late after splenectomy. Thrombocytosis occurring immediately after splenectomy, which is almost inevitable, should be treated with heparin or other anticoagulants. In the late period the avoidance of persistent severe anaemia seems to be important in the prevention of thrombotic complications due to reactive thrombocytosis in splenectomized patients.

Adult↗
PubMed1981

Spleen scanning with 99Tcm-labelled red blood cells after splenectomy.

In order to correlate the haematological changes which occur after splenectomy, with the presence or absence of residual splenic tissue, spleen scans using 99Tcm-labelled red blood cells were performed in 36 patients who had had a splenectomy. Positive spleen scans were found in 44 per cent (8 out of 18) of patients who had undergone splenectomy for trauma and in 17 per cent (3 out of 18) of patients who had undergone elective splenectomy. No relationship was found between the presence of Howell-Jolly bodies, platelet counts, the levels of IgG, IgM and IgA and the scan result. It is concluded that these findings are due to the presence of splenunculi, whose incidence is more common than the 12 per cent usually quoted.

Adolescent↗
PubMed1987

Splenectomy in the management of haematological disease.

Patients, both adults and children, with various haematological disorders who had splenectomy electively in the diagnosis, staging or treatment of their condition during a 15-year period in the Aberdeen hospitals were reviewed. The outcome regarding the disease and the immediate and long-term complications of splenectomy in this group of 185 patients are presented. Splenectomy has an acceptably low morbidity, even in patients with serious haematological disease, in the hands of an experienced surgical team, where there is close co-operation between surgeon and haematologist. Occasionally, late overwhelming infections may occur, despite prophylaxis with penicillin and pneumococcal vaccination. It seems likely that, in their zeal to report such hazards, authors may allow the pendulum against splenectomy to swing too far, in the direction of leaving patients, especially adults, with considerable symptoms and poor health, rather than risk the occasional consequences of the asplenic state.

Adolescent↗
PubMed1990

Immunodeficiency following splenectomy in the early postimmunization period.

Splenectomy is associated with an increased risk of serious infection with encapsulated micro-organisms in a small number of individuals. The immunological defects in this state are unclear. We have investigated in rabbits the effect of splenectomy, before and after primary immunization with a specific antigen (sheep erythrocytes) similar in structure to the pneumococcal capsular antigen, on the organ localization of antibody forming cells and the long-lived memory cells. Antibody forming cell and memory cell assays were performed at intervals up to day 270 after primary immunization. Antibody titres following secondary immunization were also measured. The results show that the major site of antibody forming cells is in the spleen following primary immunization of the untreated rabbit and that antibody forming cells subsequently migrate to the lymph nodes and thymus. On the other hand, in rabbits splenectomized before primary immunization the major site of the antibody forming cells is the peripheral lymph nodes. These rabbits also gave good secondary immune responses. However, splenectomy 40 days after primary immunization results in a poor secondary immune response, indicating that essentially all the antibody forming cells following primary immunization were localized in the spleen at the time of splenectomy.

Animals↗
PubMed1993

Splenectomy in human immunodeficiency virus-related thrombocytopenia.

To evaluate the efficacy and safety of splenectomy in patients with human immunodeficiency virus (HIV)-related thrombocytopenia, 30 HIV-infected patients with thrombocytopenia (platelet count < 50 x 10(9)/l) who underwent splenectomy were followed prospectively for a mean period of 42 months. There were no perioperative deaths and morbidity was minimal. Twenty-one patients had a persistent complete response, six had a partial response and were asymptomatic after splenectomy, and only three showed no response. Three patients developed acquired immune deficiency syndrome during follow-up, an incidence that was no different from that expected. Splenectomy is a safe and effective treatment in HIV-infected patients with severe symptomatic thrombocytopenic purpura resistant to medical therapy.

Adolescent↗
PubMed1996

Impact of splenectomy on circulating immunoglobulin levels and the development of postoperative infection following total gastrectomy for gastric cancer.

Splenectomy increases the postoperative morbidity of total gastrectomy for carcinoma of the stomach. The reasons for this increased risk of postoperative infection are unknown. The aim of this study was to evaluate the impact of splenectomy on circulating immunoglobulin levels and to determine whether splenectomy was an independent risk factor for the development of postoperative infection in 154 patients undergoing total gastrectomy for carcinoma of the stomach. Splenectomy reduced circulating immunoglobulin M levels in the early postoperative period following total gastrectomy. However, it was not identified as an independent risk factor for the development of postoperative infection by multivariate analysis.

Female↗
PubMed2006

Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer.

BACKGROUND: Preservation or removal of the spleen during total gastrectomy for proximal gastric cancer is a matter of debate. METHODS: A randomized clinical trial included patients with gastric adenocarcinoma who underwent total gastrectomy either with (104 patients) or without (103) splenectomy. Postoperative outcome in the two groups was compared, including morbidity, mortality and survival. RESULTS: Gastrectomy combined with splenectomy tended to be associated with slightly higher morbidity and mortality rates, a slightly greater incidence of lymph node metastasis at the splenic hilum and along the splenic artery, and marginally better survival, but there were no statistically significant differences between the groups. Splenectomy had no impact on survival in patients with metastatic lymph nodes at the hilum of the spleen or in those with metastatic lymph nodes along the splenic artery. CONCLUSION: These results do not support the use of prophylactic splenectomy to remove macroscopically negative lymph nodes near the spleen in patients undergoing total gastrectomy for proximal gastric cancer.

Adenocarcinoma↗
PubMed1991

Effects of splenectomy on pulmonary metastasis and growth of SC42 carcinoma transplanted into mouse liver.

The carcinoma SC42 was transplanted into the liver of its syngeneic mice DS, and the immunological integrity of the spleen and the effects of splenectomy on the growth and pulmonary metastasis of the liver tumor were assessed. On day 7 after liver tumor transplantation, the natural killer (NK) activity of the splenocytes was significantly elevated; it subsequently decreased at a later stage of the tumor. The response of the splenocytes to PHA and Con-A decreased significantly from the early stage of the tumor. However, the mixed lymphocyte-tumor cell reaction increased significantly from day 14 to day 28. The survival rate of the mice, which had undergone simultaneous splenectomy and liver tumor transplantation, was significantly lower than that of sham-operated control mice. The number of pulmonary metastases in splenectomized mice was significantly greater than in the control mice. There was, however, no difference between the two groups in the weight of the liver tumor. By contrast, splenectomies performed 14 days before or 14 days after tumor transplantation had no significant influence on the survival of the mice. Splenectomies performed on day 0 and on day 3 after tumor transplantation significantly increased the number of pulmonary metastases. Furthermore, the intravenous injection of anti-asialo GM1 antisera on day 0 and day 3 significantly increased the number of pulmonary metastases, but injection of anti-Thy 1.2 antisera had no effect. These results suggest that splenic NK cells may play an important role in the suppression of pulmonary metastasis at early stages of the liver tumor.

Animals↗
PubMed1990

[Subjective sequelae of splenectomy].

111 of 806 former patients splenectomized at the Würzburg university hospital during the years 1968-1983 were interviewed for their complaints since their operation. Investigations included the use of Beck's inventory for measuring depression and the Giessen questionnaire for the evaluation of general complaints used in psychosomatic medicine. There was a significant increase of symptoms after splenectomy as compared to the normal population. A special list of 18 questions to investigate typical postsplenectomy complaints was answered by 95 of these 111 persons and by a control group of "statistical twins" with similar upper abdominal surgery without splenectomy. The leading difference was the highly significant increase of the susceptibility to infections after splenic loss followed by accelerated exhaustion and increased physical and mental weakness. The distribution of other complaints like for instance the intolerance to alcohol hitherto judged as typical sequelae of splenectomy was not statistically different in both splenectomy was not statistically different in both groups. Since the symptoms listed above as significantly increased in the splenectomized patient were closely correlated with the susceptibility to infection they seem to be rather the expression of the decreased resistance than direct consequences of the loss of the spleen.

Adolescent↗
PubMed1994

Laparoscopic splenectomy.

Laparoscopic splenectomy was attempted in 16 patients and was performed successfully in 13 (81%) patients with the diagnosis of idiopathic thrombocytopenic purpura (ITP), AIDS-related thrombocytopenia, Hodgkin's disease, or lymphoma. The operative time averaged 157 min, and autologous transfusion was required in four patients. The postsurgical stay averaged 3 days in patients with completely laparoscopic splenectomies and 4 days in patients whose spleens were removed through small counterincisions. No major complications secondary to the procedure itself occurred postoperatively. Conversion to open operation was necessary in three (19%) patients because of bleeding or splenomegaly. With careful selection of patients and mastery of the technique, laparoscopic splenectomy can be safely performed on normal or slightly enlarged spleens. The advantages are less pain, shorter hospitalization, and reduced disability as compared to "open" splenectomy.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Prophylactic effect of human immunoglobulin against pneumococcal post-splenectomy sepsis in the rat.

Failure to clear the blood of pneumococci after splenectomy may be corrected by active immunization, but some patients show poor antibody response to pneumococcal vaccination. Long-term antibiotic prophylaxis against post-splenectomy sepsis carries the risk of development of bacterial resistance and low patient compliance. In the present study, using a rat model for post-splenectomy sepsis, human immunoglobulin was given 24 h before challenging the animals with 10(3) Streptococcus pneumoniae. Immunoglobulin at a dosage of 300 mg/kg body weight was protective. Reducing the immunoglobulin dose to 75 mg/kg did not alter the mortality rate but significantly prolonged the survival time. The results indicate that the new immunoglobulin preparations for intravenous use might provide an effective means of reducing the risk of post-splenectomy sepsis, even in the most susceptible patients.

Animals↗