Coloepiploic mobilization during left radical nephrectomy for renal cell carcinoma is indicated to reduce the risk of iatrogenic splenectomy

Méjean, Arnaud; Chrétien, Yves; Vogt, B; Cazin, Sébastien; Balian, C.; Thiounn, Nicolas; Dufour, B

doi:10.1016/s0090-4295(01)01549-7

Cited by 6 publications

(7 citation statements)

References 11 publications

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“…To our knowledge, the present study represents the first to examine the risk factors and outcomes for iatrogenic splenectomy during nephrectomy. In this large retrospective cohort, the incidence of splenectomy was 0.8% and is consistent with recent series where the incidence ranged from 1.3 to 4.3% . Specifically, Cooper et al .…”

Section: Discussionsupporting

confidence: 91%

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Iatrogenic splenectomy during nephrectomy for renal tumors

et al. 2013

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Abbreviations & AcronymsObjectives: To evaluate risk factors associated with iatrogenic splenectomy during nephrectomy and to assess outcomes among patients undergoing nephrectomy for renal tumors. Methods: Of 4323 patients who underwent nephrectomy at Mayo Clinic between 1992 and 2008, 33 (0.8%) had an iatrogenic/unplanned splenectomy. In a case-control study design, controls without splenectomy were matched 1:3 based on age, sex, surgical date, side of the renal tumor, surgical approach and surgeon. Perioperative features and survival were evaluated using conditional logistic and Cox regression. Results: Among the 33 iatrogenic splenectomy patients, the majority (94%) underwent radical, open and left-sided nephrectomy. Primary tumor classification ՆT3 was the only clinicopathological risk factor significantly associated with splenectomy (odds ratio 3.4; P = 0.02). Compared with controls, patients with an iatrogenic splenectomy were more likely to have longer operative time (205 vs 171 min; P = 0.02), higher estimated blood loss (1.3 vs 0.3 L; P = 0.001), longer length of stay (median 7 vs 5 days; P = 0.03) and a higher likelihood for postoperative complications (odds ratio 5.3; P = 0.002). With a median of 9.8 years of follow up, splenectomy patients tended to have greater all-cause mortality (hazard ratio 1.6; P = 0.07), although this difference approached statistical significance. Conclusions: Iatrogenic splenectomy is a rare complication during nephrectomy and is associated with locally advanced tumors (ՆpT3). It also carries prognostic significance for adverse perioperative outcomes and possibly diminished survival, although this warrants further study.

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Section: Discussionsupporting

confidence: 91%

“…More recently, Mejean et al . found an initial splenectomy rate of 8% in their series; however, after implementing a novel technique called coloepiploic mobilization through an anterior subcostal approach, their incidence fell to 1.3% without increased abdominal complications …”

Section: Discussionmentioning

confidence: 94%

Iatrogenic splenectomy during nephrectomy for renal tumors

et al. 2013

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“…7,8 In the largest series of 418 cases, the incidence was detected at 4.3%. 9 There is little data on the true incidence of splenic injury, indications of splenectomy, and any attempt of splenic salvage during left nephrectomy (Table 1).…”

Section: Resultsmentioning

confidence: 97%

“…Mejean and colleagues reported 1 of 4 splenic injuries treated conservatively. 7 Carmignai and colleagues reported a reduction in iatrogenic splenectomy from 13.2% to 2.6% after they switched their skin incision from a subcostal anterolateral transabdominal one to a cruciate Mercedes-Benz incision. 8 ISIs are caused by a variety of factors, such as mobilization of the colon, division of adhesion, mobilization of the pancreas, and inadvertent trauma from retractor.…”

Section: Discussionmentioning

confidence: 99%

Experience with sliding-clip splenorrhaphy for splenic injury during radical nephrectomy

Giri

Abdelrahman

Flood

2015

CUAJ

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Introduction: We report our experience with sliding-clip splenorrhaphy (SCS), a novel splenic conservation technique, for iatrogenic splenic injury (ISI) during a left radical nephrectomy (RN). We also reviewed the literature on ISI. Methods: We retrospectively reviewed data from patients who had RN between January 2005 and December 2013 at our institution. The technique used was similar to sliding-clip renorrhaphy. Our Medline literature identified articles containing "splenic injury during nephrectomy," "iatrogenic splenic injury." "iatrogenic splenectomy," and "splenorrhaphy." Our primary outcome measures included incidence of splenic injury and splenic conservation rate and splenectomy. Results: Among the 370 RN, 140 were left sided. ISI injury occurred in 6 left RN (incidence 1.6% for all nephrectomies, 4.2% for leftsided nephrectomies). All 6 cases had open procedure and for the left-sided procedure. Splenic conservation was attempted in 4 patients using SCS and 3 out of 4 were successfully repaired. Altogether 3 patients had splenectomy (incidence 0.8% for all nephrectomies, 2.1% for left-sided nephrectomies). Our literature review revealed that the incidence of iatrogenic splenectomy during left nephrectomy varies from 1.3% to 13.2%. Conclusions: SCS is an acceptable novel splenic conservation technique due to its ease of use and success in selected patients with ISI. There is little evidence on the true incidence of ISI especially on splenic conservation during nephrectomy. Every attempt at splenic conservation is likely to improve immediate-and long-term patient outcomes.

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“…In addition, another possible approach to the spleen is through the lesser sac in the middle. Mejean et al [6] reported a 1.3% incidence of iatrogenic splenectomy through a transperitoneal anterior subcostal incision with coloepiploic mobilization.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Splenectomy during Left Nephrectomy: A Single-Institution Experience of Eight Years

et al. 2011

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Introduction: Iatrogenic injury to the spleen is not an uncommon complication. Left nephrectomy has been reported as the second commonest cause of iatrogenic splenectomy with a reported incidence between 1.3 and 24%. Iatrogenic splenectomy is associated with significant morbidity and mortality. Aims: We reviewed the occurrence of iatrogenic splenectomy during left nephrectomy at our centre. Our aims were to determine the incidence of iatrogenic splenectomy within the Mid Yorkshire Hospitals NHS Trust in order to understand the nature of the splenic injury and the morbidity and mortality associated with it. Methods: All splenectomy and nephrectomy histology reports from January 2000 to December 2007 were reviewed retrospectively. Indications for splenectomy and nephrectomy were identified. Patients’ demographic data, tumour characteristics, operative details, length of hospital stay and any reported morbidity or mortality were collected. Results: A total of 447 nephrectomies were identified which included 234 left nephrectomies. Within the same period 136 cases of splenectomy were performed. Thirty-four cases were iatrogenic splenectomies and 12 were caused by left nephrectomy. The incidence was 5.13%. The male to female ratio was 1:1 with an average age of 66 years. Grade 2 and stage pT2 renal cancer were the commonest tumour characteristics. All iatrogenic injuries occurred during mobilisation of the colon or division of adhesion. The average operative time was 4.7 h. Average length of hospital stay was 14 days. Five patients had postoperative complications and 1 died of respiratory failure and sepsis. Conclusion: Splenic injury during left nephrectomy is a morbid complication. A good understanding of anatomy and surgical approach may reduce the incidence, morbidity and mortality of iatrogenic splenectomy during left nephrectomy.

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Coloepiploic mobilization during left radical nephrectomy for renal cell carcinoma is indicated to reduce the risk of iatrogenic splenectomy

Cited by 6 publications

References 11 publications

Iatrogenic splenectomy during nephrectomy for renal tumors

Iatrogenic splenectomy during nephrectomy for renal tumors

Experience with sliding-clip splenorrhaphy for splenic injury during radical nephrectomy

Iatrogenic Splenectomy during Left Nephrectomy: A Single-Institution Experience of Eight Years

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