Clinical significance of splenectomy for colorectal cancer metastases to the spleen

Abstract

Background. The value of splenectomy for secondary splenic tumors remains unclear. The aim of this study was to disclose the clinical significance of splenectomy for colorectal cancer metastases to the spleen by reviewing our two patients and the 24 other patients reported thus far. Methods. We report two patients with splenic metastasis from colonic cancer. A review of 26 cases, including ours, was conducted. Results. One of our patients had isolated splenic metastasis and is alive with no evidence of disease 14 months after splenectomy, while the other had non-isolated splenic metastasis and died of disseminated disease 17 months after splenectomy. In the 26 patients overall, the outcome of those with isolated splenic metastasis (n ϭ 20) was significantly better than that for those with non-isolated splenic metastasis (n ϭ 6; P ϭ 0.05). There were three long-term (more than 3 years) survivors; all three were patients with isolated splenic metastasis, with the longest survival being 110 months. Patients with mucinous carcinoma showed a better survival rate than patients with other histological types (P ϭ 0.08). In patients with isolated metastasis, metastases after splenectomy occurred in the peritoneum (n ϭ 3), liver (n ϭ 1), and lung (n ϭ 1) within 2 years. Conclusions. Splenectomy may provide long-term survival for patients with isolated colorectal cancer metastasis to the spleen. The mucinous variant may be a favorable prognostic factor after splenectomy. Recurrence after splenectomy is likely to occur within 2 years, mainly in the peritoneum.

A Glimpse into the Role and Effectiveness of Splenectomy for Isolated Metachronous Spleen Metastasis of Colorectal Cancer Origin: Long-Term Survivals Can Be Achieved

“…The search in the abovementioned databases identified 83 patients with splenectomies for metachronous isolated SM of CRC origin (no other sites of metastases at the time of splenectomy for SM), extracted from papers published between 1965 and 2024 (Supplementary Table S1, references [16][17][18]20, are cited in Supplementary Materials). The median age of patients at the time of splenectomy was 62 years (range, 22-84 years), with a slightly male gender predominance (50.6%).…”

“…Several studies reviewing the patients with splenectomies for SM of CRC origin reached conflicting results about the number of published cases [16][17][18]. In a study published in 2007, 42 patients with isolated SM of CRC origin were described in the literature [19], while another study published in 2016 identified 48 patients with SM of CRC origin [20].…”

“…An elevated CEA serum level was observed in 55% to 83.9% of the patients at the time of SM diagnosis, while the imaging diagnosis included CT scan in 87.1% of the patients and PET-CT in 12.9% of the patients. A metachronous pattern for SM was reported in 83.9-92.9% of the patients, the most significant portion of SM being solitary (92-99%) and treated with splenectomy (94-96.4%) [17][18][19][20]22,65,87].…”

“…Many papers exploring the role and effectiveness of resection of metastases in CRC have focused mainly on liver and lung sites or limited peritoneal disease [8]. Only a few papers have examined the potential role of resection for rare sites of CRC metastases, such as splenic metastases (SMs) [16][17][18][19][20][21][22]. Thus, SM from CRC generally occurs in the context of advanced metastatic disease, usually after cancer has spread to sites such as the liver, lungs, peritoneum, and other sites [4,7,23].…”

“Splenic Metastasis Secondary to Sigmoid Colon Carcinoma: A Case Report and Literature Review”

“…Furthermore, the reticuloendothelial system inhibits the aggregation of the nest of cancer cells in splenic sinusoids (14). Vascular and lymphatic route of transmission of splenic metastasis has been proposed for colorectal cancer .It is believed that vascular transmission is the primary route for the development of splenic metastasis, because the metastasis is reported to be located within the splenic parenchyma, with the lymph nodes at the hilus negative for metastasis in majority of case (10,15,16) .It is hypothesized that probably because of reflux of blood from the inferior mesenteric vein in the splenic vein and then to the spleen is responsible for cancer cells to reach the splenic parenchyma. This is in relation to the localization of the primary tumor to the left hemicolon in the majority of the patients with splenic metastasis (17) .In our case, the primary tumor was in the sigmoid colon which is similar to literatures which suggest left hemicolon as a frequent site.…”