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At least 19 recordsLinked to original sources
PubMed1997

Role of splenectomy in gastric cancer surgery: adverse effect of elective splenectomy on longterm survival.

BACKGROUND: Splenectomy, and in some cases pancreatico splenectomy, has been advocated by surgeons in an effort to improve clearance of metastatic nodes to splenic hilum (node 10) and splenic artery (node 11). Although splenectomy has known effects on increasing morbidity and even mortality after a variety of surgical maneuvers including gastrectomy, the longterm effect on survival is controversial. The purpose of this study is to review and analyze the effect of splenectomy on survival in patients having curative gastrectomy for stomach cancer. METHODS: We reviewed the role of splenectomy in patients having curative gastrectomy in a data base of stomach cancer patients that had been collected in 1987 as part of an American College of Surgeons Patterns of Care Study. This analysis had involved 18,344 patients, of whom 11,252 were first diagnosed in 1982 as part of a longterm study, and 7,092 were first diagnosed in 1987 as part of a shortterm study. From the two data collection periods information was available on 12,439 patients who received cancer directed abdominal surgery; 21.2% of these patients received a splenectomy. Among the 3,477 patients reported as having a curative gastrectomy (pathologically clear margins), 26.2% received a splenectomy. RESULTS: The operative mortality was 9.8% with splenectomy and 8.6% without splenectomy. In patients having a curative gastrectomy, the 5-year observed survival rate was 20.9% in patients having splenectomy versus 31% in patients who did not receive splenectomy (p < 0.0001). Examination of differences in survival by stage of diagnosis showed significantly reduced survival outcomes among patients with stage II and III, but not for those diagnosed with stage I or IV disease. The pattern of recurrence was moderately different with a larger proportion of patients having distant metastases among the group of patients who had undergone splenectomy compared with the patients who had not, 29% and 15.5%, respectively. Whether these differences are inherent in the splenectomy or in the associated cofactors was not determined in this study. CONCLUSIONS: The data suggest elective splenectomy should generally be avoided in patients with stage II and III gastric cancer. In patients with resectable proximal advanced (stage IV) cancer or who have extension to spleen and pancreas or macroscopic nodal metastases to splenic hilum, splenectomy might be necessary to facilitate complete removal of the tumor in an effort to achieve longterm tumor control. The importance of surgical judgment is emphasized as the major deciding factor in determining the need for splenectomy in the individual cancer patient.

Elective Surgical Procedures↗
PubMed1996

Laparoscopic splenectomy by the lateral approach: a safe and effective alternative to open splenectomy for hematologic diseases.

BACKGROUND: The purpose of this study was to compare the clinical outcomes and expense of laparoscopic splenectomy by the lateral approach with open splenectomy for the treatment of hematologic diseases. METHODS: Medical records of 20 matched patients undergoing open splenectomy and lateral approach laparoscopic splenectomy were retrospectively reviewed detailing perioperative course, clinical outcome, and hospital charges. RESULTS: Patients undergoing laparoscopic splenectomy (n = 10) experienced longer anesthesia (324 versus 176 minutes; p < 0.05) and operative times (261 versus 131 minutes; p < 0.05) than those undergoing open splenectomy (n = 10). No difference was noted in both intraoperative and postoperative packed red blood cells transfused. Laparoscopic splenectomy resulted in a shorter duration of nasogastric decompression (1.2 versus 2.6 days), more rapid resumption of normal oral intake (1.9 versus 4.4 days), and earlier hospital dismissal (3.0 versus 5.8 days). Although hospital charges were not significantly higher in the laparoscopic group ($17,071.00 versus $13,196.00; p > 0.05), operative charges were always significantly higher. CONCLUSIONS: When compared with open splenectomy, lateral approach laparoscopic splenectomy allows a more rapid return of normal gastrointestinal function and shorter hospital stay. The operative expense of laparoscopic splenectomy is significantly higher; however, the overall hospital expense is not. If costs can be decreased, the lateral approach laparoscopic splenectomy will be the preferred operative approach.

Adult↗
PubMed1998

Splenectomy for HIV-related immune thrombocytopenia: comparison with results of splenectomy for non-HIV immune thrombocytopenic purpura.

OBJECTIVE: To determine the effectiveness and safety of splenectomy for patients with human immunodeficiency virus (HIV)-related immune thrombocytopenia, using the results of splenectomy for patients with non-HIV immune thrombocytopenic purpura as a control group for comparison. DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PATIENTS: Fourteen patients who underwent splenectomy for symptomatic, medically refractory HIV-related immune thrombocytopenia at this hospital from 1988 to 1997. During the same period, 20 patients had splenectomy for treatment of non-HIV immune thrombocytopenic purpura. INTERVENTION: Splenectomy. MAIN OUTCOME MEASURES: Platelet response, need for postsplenectomy medical therapy, progression of HIV disease, and complications. RESULTS: All patients with HIV-related thrombocytopenia had a complete early platelet response to splenectomy, with an elevation of the platelet count to greater than 100X10(9)/L. After a median follow-up of 26.5 months, all but 1 patient had a sustained complete remission with no need for medical therapy for thrombocytopenia. Splenectomy was more effective in the HIV-related thrombocytopenia group than in the non-HIV immune thrombocytopenic purpura group, with significantly higher platelet counts at 1 week and 1 month after splenectomy in the HIV group (t test, P=.02 and P=.009, respectively). There were significantly fewer patients needing medical therapy for thrombocytopenia after splenectomy in the HIV group (chi2 test, P=.02). There were no remarkable short- or long-term complications in the patients with HIV infection, including no overwhelming postsplenectomy infections. Three patients have died, and 2 patients have developed AIDS since operation. CONCLUSIONS: Splenectomy is effective treatment for patients with symptomatic HIV-related thrombocytopenia that is resistant to medical therapy. The effectiveness of this treatment suggests that the predominant mechanism of thrombocytopenia in HIV-infected patients is increased destruction of platelets because of platelet-associated immunoproteins.

Adolescent↗
PubMedDate not supplied

[Long-term effects of splenectomy for immune thrombopenic purpura related to human immunodeficiency virus. A retrospective study from 2 groups, with and without splenectomy].

In order to evaluate the long-term effects of splenectomy in patients with human immunodeficiency virus-related immune thrombocytopenic purpura (ITP), we studied retrospectively two populations of patients: 21 had undergone splenectomy and 18 had not. At the time of diagnosis the first population had on average lower platelet counts than the second one. After a mean follow-up of 47 +/- 9 months the situation has been reversed: the population that underwent splenectomy had significantly higher platelet counts than that without splenectomy (190.600 +/- 55.300/mm3 versus 91.500 +/- 55.300/mm3, P less than 0.001). Moreover 76 percent of the patients with splenectomy versus 50 percent in the population without splenectomy were in complete remission of ITP at the last follow-up. It therefore seems that splenectomy had a statistically positive effect on platelet counts without worsening the immune status. Indeed, the clinical course towards AIDS was the same in both populations (35 percent in patients with splenectomy and 22 percent without, P = NS). Following splenectomy, the total blood lymphocytes count was increased, especially the CD8 population, while the CD4 count remains unchanged; these findings seem to be a common feature after splenectomy.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Experimental study of the effects of splenectomy and partial splenectomy on bacterial translocation.

BACKGROUND: The aim of this study is to evaluate the effect of splenectomy and partial splenectomy in a burn-induced bacterial translocation model and to study Kupffer cell (KC) morphology and number. METHODS: Mice were divided into sham-burn and burn groups. Each group was also subdivided to sham-splenectomy, partial-splenectomy, and splenectomy subgroups. At day 0, operations were performed. At the postoperative 10th day, a sham burn or burn injury was made in all animals. Twenty-four hours later, cultures for bacterial translocation were obtained and livers were evaluated for the quantity and morphology of KCs. RESULTS: Burned-splenectomized animals had significantly decreased bacterial translocation when compared with sham-splenectomized animals (p = 0.031). Interestingly, in both the sham-burned and burned groups, splenectomy subgroups had significantly higher numbers of KCs compared with partial-splenectomy and sham-splenectomy subgroups (p<0.00000). Burn injury caused a significant decrease of KC numbers in all subgroups compared with their correspondent sham-burned subgroups (p<0.05). CONCLUSION: Results revealed that splenectomy decreases bacterial translocation and also increases the number of KCs.

Animals↗
PubMed1994

Partial splenectomy in children: an alternative for splenectomy in the pathological staging of Hodgkin's disease.

BACKGROUND: The more accurate staging of Hodgkin's disease in children is achieved with a staging laparotomy and splenectomy. A disadvantage of the splenectomy is the high risk for an overwhelming postsplenectomy sepsis (OPSI). Therefore, the partial splenectomy was introduced as an alternative to splenectomy in the staging of Hodgkin's diseases in children. METHODS: During the period 1982-1988, 12 children with Hodgkin's disease underwent a staging laparotomy with partial splenectomy. All patients were preoperatively vaccinated with Pneumococcus vaccine. The first three patients received 44 Gy locoregional radiotherapy, whereas nine patients received 25 Gy locoregional radiotherapy and two courses of MOPP/ABVD (mitoxin, oncovin [vincristine], procarbazine, prednisone/adriamycin, bleomycin, vinblastine, decarbazine). RESULTS: The morbidity was negligible. The pathological stage changed in three patients (25%). During a median follow-up of 6 years (range 4-10), no OPSI was diagnosed. One patient developed a secondary leukaemia. CONCLUSIONS: Staging laparotomy for Hodgkin's disease is being performed with less frequency because the majority of patients are treated with chemotherapy and low-dose radiation therapy. After splenectomy and chemotherapy regimens with alkylating agents, there is an increased risk for secondary acute leukemia. With partial splenectomy an adequate staging of the disease can be achieved, allowing a more tailored therapy so that systemic chemotherapy will not be used as frequently, resulting in a lower treatment morbidity without decreasing survival.

Adolescent↗
PubMed1989

Influence of splenectomy, partial splenectomy and splenic artery ligation on E. coli sepsis in rats.

Male Sprague-Dawley rats were allocated to four groups--sham operation, partial splenectomy, splenic artery ligation or total splenectomy, and 4 weeks after the operation 3 x 10(8) colony-forming units of Escherichia coli were injected intraperitoneally. Among the splenectomized rats the mortality was significantly (p less than 0.02) increased compared with the controls, while both partial splenectomy and splenic artery ligation did not influence survival. Blood clearance and organ (liver, spleen and lungs) uptake of intravenously injected, radiolabelled, heat-killed E. coli were determined 1 hour after the intraperitoneal challenge. Splenectomy caused a significant decrease in blood clearance. Splenic uptake of radiolabelled E. coli was significantly reduced following partial splenectomy and splenic artery ligation. The splenic operations increased hepatic uptake expressed per gram tissue. Splenectomy thus resulted in reduced blood clearance and increased mortality in Gram-negative sepsis, while the reduced splenic uptake following partial splenectomy or splenic artery ligation did not influence blood clearance of E. coli or mortality.

Animals↗
PubMedDate not supplied

Laparoscopic splenectomy versus open splenectomy: a comparative study.

BACKGROUND/AIMS: In 1993, we reported a new technique for laparoscopic splenectomy, namely the "hanging spleen" technique. The patient was placed in a right lateral supine position with the operator being located on the right of the patient. We herein report the results of 28 laparoscopic splenectomies performed with this technique until January 1996. MATERIAL AND METHODS: From 1993 to 1996, the results were compared with those of 28 patients operated on by open splenectomy from 1988 to 1995. The two groups were similar in terms of age, sex-ratio, and physical condition (ASA classification). Indications for splenectomy were the following in each group: idiopathic thrombocytopenic purpura (ITP) (n = 26 and 27, respectively) and hemolytic anemia (n = 2 and 1, respectively). RESULTS: Accessory spleens were found in 3 patients of the laparoscopic group and in 5 patients of the open group. Three conversions to open procedure were necessary in the laparoscopic group, but two conversions might have been avoided. We have observed significant advantages in the laparoscopic approach: shorter ileus and postoperative stay. On the other hand, the procedure was longer than with open splenectomies. Three patients had postoperative complications in the laparoscopic group, whereas nine patients had complications in the open group. Recurrence of ITP was observed in 2 patients of the laparoscopic group and in 4 patients of the open group. CONCLUSION: Our results suggest that laparoscopic splenectomy may be considered as a safe alternative to open splenectomy in patients with hematological diseases such as ITP and hemolytic anemia.

Adolescent↗
PubMed1999

Laparoscopic splenectomy for immune thrombocytopenic purpura--long-term result of 40 laparoscopic splenectomies.

Laparoscopic surgery has recently extended its indications and it has also become an acceptable surgical approach for splenectomy. In the last five years, we have performed 40 laparoscopic splenectomies for immune thrombocytopenic purpura. Thirty-five patients were female and 5 patients were male. The mean age was 34, varying from 17 to 56. After learning to perform laparoscopic splenectomy with five ports, we are now usually using three or four ports in a right lateral kidney position. There was no case of conversion to exploratory laparotomy. The mean hospital stay was 7 days. There was no perioperative mortality; but in 2 cases we had postoperative subphrenic abscesses which were successfully managed by catheter drainage. Since undergoing laparoscopic splenectomy, 28 patients (70%) were weaned effectively from their steroid medications. Eight patients (20%) have been on small doses of steroid, and 4 patients (10%) have been on the same doses of steroid with no response. The patient group with rapidly increasing platelet count after splenectomy showed a statistically significant relation with the complete response group (p < 0.001). Laparoscopic splenectomy is a safe and reasonable operative procedure for patients with immune thrombocytopenic purpura.

Adolescent↗
PubMed2001

Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura: only splenectomy induces a complete remission.

Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous disease, whereby it is unclear if and in which way prednisone and splenectomy affect the platelet kinetics leading to a complete remission. To determine the effects of prednisone and splenectomy on the mean platelet life (MPL) and platelet production, platelet kinetic studies with Indium-111 tropolonate-labeled autologous platelets were performed in patients with ITP ( n=41). In 17 patients platelet kinetic studies were performed before and during prednisone treatment, and in 24 patients before and after splenectomy. MPL increased after prednisone therapy only in patients ( n=13) with a full recovery (FR, platelets >150 x 10(9)/l) and partial recovery (PR, 50 x 10(9)/l <platelets <150 x 10(9)/l) from 2.1+/-1.5 days to 4.9+/-1.3 days in FR patients (p=0.03) and from 1.1+/-0.8 days to 2.4+/-1.1 days in PR patients, which is significantly shorter than in normal controls (9.2+/-1.2, p<0.0001). The platelet production demonstrated an impressive increase (threefold) during prednisone treatment in all responding and nonresponding patients. These results suggest that the clinical response to prednisone is more related to the effect on MPL than on platelet production. In contrast, the group of splenectomized patients showed that a full recovery of platelet count was associated with near normalization of the MPL (2.4+/-1.6 days vs 8+/-1.4 days) and platelet production (119+/-60 vs 162+/-35 x 10(9)/day). These results demonstrate that prednisone as well as splenectomy increase MPL and production in patients with ITP. However, only after splenectomy is a complete remission obtained, defined as a normal platelet count, mean platelet life, and platelet production.

Adult↗
PubMed1985

Impaired human antibody response to the thymus-independent antigen, DNP-Ficoll, after splenectomy. Implications for post-splenectomy infections.

A synthetic thymus-independent (TI) antigen, dinitrophenyl-'Ficoll', was used to immunise controls, untreated patients with Hodgkin's disease (HD), and patients who had had splenectomy (most for staging in HD). The antibody response to DNP-ficoll was much lower in splenectomised patients than in the other groups and the antibody titres 7, 14, and 21 days after immunisation of splenectomised patients were approximately a tenth of the titres in the other groups. In contrast patients who had been primed with DNP-ficoll before splenectomy responded normally to re-immunisation 6-28 months after splenectomy. These results suggest that the antibody response upon first exposure to certain TI antigens occurs mainly in the spleen. Antibody responses are not generally impaired in splenectomised patients immunised with pneumococcal or other bacterial polysaccharides, probably because natural exposure and priming by these TI antigens before splenectomy are widespread. However, such patients must be vulnerable to overwhelming infection by encapsulated bacteria not met before splenectomy.

Antibody Formation↗
PubMed1984

Long-term effect of splenectomy versus no splenectomy in renal transplant patients. Reanalysis of a randomized prospective study.

In 1980 we determined the patient and renal allograft survival in 299 kidney transplants recipients who, between 1976 and 1979, were randomized to splenectomy (n = 146) versus nonsplenectomy (n = 152), and who were treated with antilymphocyte globulin-azathioprine-prednisone for immunosuppression. The preliminary analysis showed significantly (P less than .05) better (10% overall, 12% for cadaver, 14% for nonidentical-related) graft survival rates at two years in splenectomized recipients. The splenectomized patients had higher white blood counts and received more azathioprine and less prednisone. We concluded that splenectomy had a beneficial effect for at least the first two years posttransplant without a detrimental effect on patient survival. Splenectomy, however, remains controversial. Thus, we reanalyzed the original cohort 7 years after the study began and 4 years after the last patient was entered. The reanalysis showed that the differences in graft survival rates between splenectomized and nonsplenectomized recipients were no longer significant. There were more late deaths from sepsis in the splenectomized group, although the overall patient survival rates were similar in splenectomized and nonsplenectomized recipients. Splenectomy modestly improved graft survival for the first few years, but the eventual fate of the graft was determined by other factors. The dominant influence on graft survival rates was the source of the kidney (at 6 years in splenectomized recipients the functional survival rate of grafts from HLA-identical siblings was 24% higher than that of grafts from HLA-mismatched relatives, which in turn was 24% higher than that of grafts from cadaver donors; in nonsplenectomized recipients the difference in 6-year function rates between HLA-identical and mismatched related grafts was 34%, and between mismatched related and cadaver grafts was 16%. Between 1979 and 1983, we performed pretransplant splenectomies in all recipients of renal allografts from HLA-mismatched related or cadaver donors. Two-year graft survival rates were 81% and 68%, respectively, in azathioprine-treated recipients, 7% and 12% higher than in the splenectomized patients in the randomized trial. (ABSTRACT TRUNCATED AT 400 WORDS)

Azathioprine↗
PubMed1986

Management of splenectomy failures in chronic immune thrombocytopenic purpura: role of accessory splenectomy.

Accessory splenic tissue was demonstrated in four of eight patients with chronic immune thrombocytopenic purpura investigated following post-splenectomy relapses. Time from initial splenectomy to relapse of thrombocytopenia ranged from immediately to eight years and post-splenectomy changes were present on the peripheral blood films of all patients at time of relapse. Three scanning techniques were employed to demonstrate and localise residual splenic tissue. Conventional 99mTc scans were positive in three of the four patients whilst 99mTc-heat damaged red cell scans and computerised tomographic scans were each positive in three out of three patients including the one patient in whom a conventional 99mTc scan was negative. Histological confirmation of splenic tissue was obtained in all cases with the weights of the accessory spleens ranging from 0.6 g to 2 g. Two patients responded to accessory splenectomy and, without immunosuppressive therapy, have remained well with normal platelet counts for over four years. There was no correlation between length of initial remission and the response to removal of the accessory spleen. The presence of a functioning accessory spleen should be considered in all patients with chronic ITP who fail to respond to, or relapse following, initial splenectomy.

Adult↗
PubMed1976

Splenectomy or radiation and splenectomy for hypersplenism in lymphosarcoma.

This is a retrospective study of 14 patients with lymphosarcoma with hypersplenism. Eight patients received radiation to the spleen followed by splenectomy for recurrence of hypersplenism. Six patients underwent primary splenectomy for hypersplenism. Radiation decreases the size of the spleen but recurrence of hypersplenism is seen in an average of 8 mo. Splenectomy in these cases improves the hematological picture. Average postsplenectomy survival is 27.6 mo. Splenectomy alone in hypersplenism also improves the hematological picture. Postsplenectomy survival in this group is 13 mo. One case of primary lymphosarcoma of the spleen is reported.

Adult↗
PubMed1997

The site of destruction of autologous 111In-labelled platelets and the efficiency of splenectomy in children and adults with idiopathic thrombocytopenic purpura: a study of 578 patients with 268 splenectomies.

The indication for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP) remains a controversial subject. The mortality rate of persistent thrombocytopenia is very low, except in severe cases. Conversely, the risks of splenectomy are significant (in the present series, morbidity: 4.1% mortality: 1.4%), with a success rate of only 60-75%. It is therefore useful to define a parameter able to predict the efficacy or failure of splenectomy. An analysis of 578 cases of chronic ITP, where the site of platelet destruction has been determined, is presented. 268 of these cases had been splenectomized. When platelet destruction was splenic, 96% of subjects aged 5-30 years and 91% of cases over the age of 30 years obtained a remission. Conversely, when platelet destruction was hepatic or diffuse, failure or incomplete results were observed in 92% of cases. The site of platelet destruction therefore constitutes a parameter which can help the clinician to make the decision to perform splenectomy.

Adolescent↗
PubMed1990

[The relationship between responsiveness to splenectomy and clinical course after splenectomy in chronic idiopathic thrombocytopenic purpura (ITP)].

Fifty-four ITP patients were treated by the protocol proposed by Japanese Idiopathic Disease of Hematopoietic Organ Research Committee. Forty-eight patients were treated with corticosteroid (CS). Twenty-eight patients out of 30 patients who were refractory to CS were splenectomized. To study natural courses of splenectomized patients, 25 patients were splenectomized without elevation of platelet counts at the operation and were followed up their platelet counts and PAIgG for one month without treatment. Clinical courses after splenectomy were classified into four types by the platelet increment followed by splenectomy and the platelet counts at one month after splenectomy; type I (markedly over-shooted platelet peak and normalized platelet counts), type II (moderate platelet peak and 50 approximately 100 x 10(3)/microliters platelets), type III (minimal platelet peak and less than 50 x 10(3)/microliters platelets), and type IV (elevation of platelet counts at day 7 or later of splenectomy and normalized platelet counts). The results of analyses from 25 patients indicated that the numbers of type I, II, III and IV were 10, 5, 6 and 4, respectively. The clinical course of type IV suggests that platelet production may be impaired by anti-platelet antibodies.

Adult↗
PubMed1987

High dose intravenous IgG followed by splenectomy versus splenectomy alone in idiopathic thrombocytopenic purpura refractory to steroids.

A total of twenty-six patients with idiopathic thrombocytopenic purpura ITP refractory to corticosteroids were alternately allocated to undergo splenectomy alone (N = 12) or to receive a 5 day course of high dose immunoglobulin G i.v. immediately followed by splenectomy (N = 14). Although there were less initial failures after splenectomy in patients receiving IgG, the proportion of sustained complete remission at 1 and 2 years was identical in both groups. It is concluded that high dose IgG infusions do not improve the results of splenectomy in refractory ITP.

Adolescent↗
PubMedDate not supplied

Complications of splenectomy. Comparative study of elective, urgent and incidental splenectomy.

In 160 patients who had undergone elective, urgent or incidental splenectomy, an assessment was made of the possible relationship between the reason for splenectomy and the postoperative course. In patients who had incidental splenectomy, the postoperative complication rate (56.6%), the hospitalization time (20.8 days), and the mortality rate (10%) were higher than among those who had elective or urgent surgery. Our results indicate that splenic injury sustained during abdominal surgery should be treated conservatively, by topical hemostasis or by suturing, in order to avoid complications related to splenectomy.

Adolescent↗