Hand-Assisted Laparoscopic Splenectomy for Splenic Tumors

Abstract

Background: The feasibility of hand-assisted laparoscopic splenectomy (HALS) for splenic tumors including benign or malignant neoplasms and the associated clinical outcome of the patients remain unclear. Methods: A total of 10 patients with splenic tumors undergoing HALS were retrospectively analyzed in this study. The intraoperative course, postoperative course, and postoperative recovery were evaluated. Results: Ten patients with splenic tumors consisted of 5 with benign tumors and 5 with malignant tumors. HALS was not converted to an open splenectomy in any of the patients. Mean operative time was 170 min (range 100–310 min). Mean estimated blood loss was 105 g (range 10–900 g). Mean splenic size and splenic weight was 13 cm and 478 g, respectively. Splenomegaly based on size or weight occurred in 50% of the patients. There were no intra- or postoperative complications. Postoperative chemotherapy was given to 4 patients with malignant tumors including metastatic carcinomas and malignant lymphomas. All the patients were alive at a mean follow-up of 26 months, ranging from 15 to 43 months after surgery. There was no port-site recurrence after surgery in our study. Mean time to first flatus, mean time to first walking, mean time to resumption of oral intake, mean length of hospital stay, and mean duration of epidural analgesia were 1.8, 1, 1.5, 10.8 and 3.1 days, respectively. The results were equal in terms of intra- and postoperative course to those seen with a standard laparoscopic splenectomy for 13 patients with idiopathic thrombocytopenic purpura. Conclusion: HALS may be a good indication for malignant tumors as well as benign tumors of the spleen.

Prospective randomized comparison of clinical results between hand-assisted laparoscopic and open splenectomies

“…Splenectomy usually is indicated for the treatment of patients with splenic vascular tumors because of the possibility that the lesion is a malignant neoplasm [23]. Hiroshi et al [24] described two cases of splenic vascular tumors successfully treated by HALS.…”

Laparoscopic splenectomy for solitary splenic tumors

“…In our series 76% of the patients were found to have malignancy, all with lymphoma. In another smaller reported series, 50% of patients with a splenic solid lesion had a malignancy, with a variety of pathologies including lymphoma and metastases [18].…”

“…Complications following LS seem to be determined by the size of the removed spleen regardless of the underlying disease, so that if patient selection is attempted, basing it on splenic size only will be a reasonable option. The potential benefit of laparoscopy in splenic tumors includes the known advantages of laparoscopy with a specific advantage for malignant tumors allowing rapid convalescence and early initiation of chemotherapy when needed [18].…”

“…Yano et al [18] reported their experience with handassisted laparoscopic splenectomy (HALS) for splenic tumors in ten patients. They advocated the HALS approach for splenic tumors as it allowed them easier mobilization of the spleen in cases of splenomegaly and easier resection of adjacent organs or tissue in cases when it was necessary.…”

“…The largest series of LS for solid tumors described included ten cases [18]. To the best of our knowledge there is no published data about LS for splenic masses found incidentally.…”