Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

Abstract

Objectives: To examine the use of splenectomy, chemotherapy, and subsequent overall survival (OS) in contemporary patients with splenic lymphomas. Methods: We analyzed records of 6450 patients with various splenic lymphomas recorded in the National Cancer Data Base (2004-2013). Survival was compared using Mantel-Byer test to account for guarantee-time bias, stratified by age, sex, comorbidities, and lymphoma stage. Results: Splenectomy rate was overall 58%, and varied from 49% in splenic marginal zone (SMZL) to 77% in follicular lymphoma (FL). It significantly decreased across all histologies over time (overall from 69% in 2004, to 44% in 2013). Thirty-day mortality after splenectomy was 4%. Chemotherapy use varied from 40% in FL to 76% in diffuse large B-cell lymphoma (DLBCL), but increased significantly only for SMZL and T-cell lymphomas over time. Overall, 57% of splenectomies were performed as diagnostic procedures, which was significantly less common in academic hospitals (p < 0.0001). Following a diagnostic splenectomy, chemotherapy was not administered to 29% of patients with DLBCL, 49% with mantle cell, and 42% with T-cell lymphomas. Median OS ranged from 12.4 years for FL to 1.0 year for Tcell lymphomas. We found no association between performance of splenectomy and OS across all histologies. Patients with DLBCL who did not receive chemotherapy after a diagnostic splenectomy had significantly worse OS (p = 0.001). The association between postsplenectomy chemotherapy and OS was not observed in FL or SMZL. Conclusion: many splenic lymphomas may be treated without surgery, but a high proportion of diagnostic splenectomies indicates an ongoing need for less invasive diagnostic modalities.

Reappraisal of surgical decision-making in patients with splenic sclerosing angiomatoid nodular transformation: Case series and literature review

“…When diagnosed, malignant splenic tumors do not always require splenectomy. Accumulating evidence has shown that splenic lymphoma can be effectively treated with immunochemotherapy, resulting in a decreasing need for therapeutic splenectomy[ 19 , 20 ]. Splenectomy for splenic lymphoma is reserved for patients who experience abdominal fullness due to large spleens and cytopenia due to spleen sequestration[ 19 , 20 ].…”

“…Accumulating evidence has shown that splenic lymphoma can be effectively treated with immunochemotherapy, resulting in a decreasing need for therapeutic splenectomy[ 19 , 20 ]. Splenectomy for splenic lymphoma is reserved for patients who experience abdominal fullness due to large spleens and cytopenia due to spleen sequestration[ 19 , 20 ]. Diagnosis of tissue proof to determine the nature of lymphoma could be another important indication of splenectomy for highly suspected systemic lymphoma with absence of a definite diagnosis from another site.…”

Successful Surgical Removal of the Largest Known Spleen

“…Additionally, splenectomy has been shown to be relatively safe. A 2019 review by Fallah and Olszewski of 6450 patients with splenic lymphoma in the National Cancer Data Base from 2004 to 2013 found that 58% of patients were treated with splenectomy, with a thirty-day overall mortality of 4% [2].…”

Pathological spontaneous splenic rupture and the use of transcatheter arterial embolization: a case series of two patients

“…While mantle cell lymphoma and plasma cell leukaemia do not typically require splenectomy for management, 7,8 there may be diagnostic and therapeutic benefits. Non‐nodal mantle cell lymphoma may have a long remission post splenectomy 9 and rituximab therapy has been linked with increased risk of PSSR 10 . The downside is that splenectomy may delay time to chemotherapy in patients with aggressive disease such as plasma cell leukaemia which benefits from early chemotherapy 9 …”

“…Non‐nodal mantle cell lymphoma may have a long remission post splenectomy 9 and rituximab therapy has been linked with increased risk of PSSR 10 . The downside is that splenectomy may delay time to chemotherapy in patients with aggressive disease such as plasma cell leukaemia which benefits from early chemotherapy 9 …”