Risk Factors for Splenic Injury During Colectomy: A Matched Case–Control Study

Wang, Jeffrey K.; Holubar, Stefan D.; Wolff, Bruce G.; Follestad, B.; O’Byrne, Megan M.; Qin, Rui

doi:10.1007/s00268-011-0994-x

Cited by 36 publications

(29 citation statements)

References 19 publications

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“…Previously‐identified risk factors for splenic injury have been largely reported from colorectal surgical literature. In one series, the single risk factor independently associated with increased risk of splenic injury was mobilization of the splenic flexure of the colon . Indications for colon surgery ranged from benign (diverticular disease) to malignant (colon and rectal carcinoma) etiologies.…”

Section: Discussionmentioning

confidence: 99%

“…Given the infrequency of this complication, few reports exist that specifically examine the relationship between iatrogenic splenectomy and adverse outcomes for patients treated with nephrectomy. Data regarding iatrogenic splenectomy in the urological setting are frequently taken from larger and more robust studies in the colon and rectal surgery literature . Although iatrogenic splenectomy among patients undergoing nephrectomy for renal tumors might be a rare adverse event, clinicopathological risk factors, such as tumor size, location and surgical approach, have yet to be investigated.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Iatrogenic splenectomy during nephrectomy for renal tumors

et al. 2013

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“…In laparoscopic low anterior rectal resection, the need to perform a complete total mesorectal excision coupled with low transection of the rectum make the whole operation technically demanding (7) . Moreover, the construction of a low colorectal anastomosis after SF mobilization allowing free descent of the left colon into the pelvis adds complexity to the procedure (2,3,10) and risk of iatrogenic injuries to spleen and retroperitoneal structures (14) . In the study conducted by Jamali et al (7) , a mail-survey of 35 experienced laparoscopic colorectal surgeons revealed that all colorectal procedures requiring SF mobilization scored high difficulty ratings.…”

Section: Discussionmentioning

confidence: 99%

Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study

Araújo

Seid

Kim

et al. 2012

Arq. Gastroenterol.

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“…1 This step is technically difficult and not without risk. There may be splenic trauma leading to bleeding and, therefore, the possible requirement to proceed to splenectomy, [2][3][4] which is associated with reduced 30-day and 5-year survival. 3 SFM is also associated with longer operative time regardless of surgery type.…”

mentioning

confidence: 99%

“…There may be splenic trauma leading to bleeding and, therefore, the possible requirement to proceed to splenectomy, [2][3][4] which is associated with reduced 30-day and 5-year survival. 3 SFM is also associated with longer operative time regardless of surgery type. 5,6 We hypothesised that the difficulty of SFM is related to the anatomical height of the splenic flexure (ie difficulty increases with distance from the midline).…”

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confidence: 99%

Anatomical siting of the splenic flexure using computed tomography

Meecham

Brookes

Macano

et al. 2017

annals

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Anatomical siting of the splenic flexure using computed tomography L Meecham, A Brookes, CAW Macano, T Stone, M Cheetham Shrewsbury and Telford NHS Trust, UK ABSTRACT INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (k) value of 0.742 (95% confidence interval (CI), 0.463-0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: k = 0.905 (95% CI, 0.785-0.961); CVBI: 0.951 (0.890-0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.

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Risk Factors for Splenic Injury During Colectomy: A Matched Case–Control Study

Abstract: Splenic flexure mobilization is the primary risk factor for splenic injury during colectomy, independent of other factors, such as higher ASA class, Charlson score, and nonelective surgery. Splenic injury during colectomy has an increased risk of death in both the short- and long-term.

Cited by 36 publications

References 19 publications

Iatrogenic splenectomy during nephrectomy for renal tumors

Iatrogenic splenectomy during nephrectomy for renal tumors

Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study

Anatomical siting of the splenic flexure using computed tomography

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