Splenectomy for Hematologic Disease

Abstract

Between 1956 and 1981, 306 splenectomies for hematologic diseases were performed at the UCLA Medical Center. Of these operations, more than 75% were performed for therapeutic reasons to control anemia, thrombocytopenia, neutropenia, or painful symptoms of splenomegaly. Of the 65 patients who had idiopathic thrombocytopenic purpura, 77% showed an excellent response, and of the 39 patients who had hereditary spherocytosis, 90% responded. Other diseases with predictably good response rates were autoimmune hemolytic anemias, Felty's syndrome, and hairy cell leukemia. Forty patients with Hodgkin's disease had splenectomies for diagnostic purposes the last 10 years. The overall morbidity and mortality were 24% and 6%, respectively, the most common complications being pneumonia, wound infections, and local postoperative bleeding, and the most common cause of death being sepsis. The review supports the thesis that in carefully selected patients, therapeutic splenectomy can have desirable palliative effects and that diagnostic splenectomy has a sufficiently low risk to warrant its consideration in patients with Hodgkin's disease.

Liver Dysfunction following Splenectomy in Idiopathic Myelofibrosis: A Study of 10 Patients

“…The 20% mortality rate associated with splenec tomy found in the present series is in agreement with the figures reported by others, that range from 10 to 20% [2, 5-13, 16, 17, 19], The high mortality and mor bidity after splenectomy in IM compared with other hematological disorders is well known [17], Finally, as in previous studies, infectious, thrombotic and hem orrhagic complications were the most frequent causes of death in our patients.…”

“…In patients with either cytopenia secondary to hypersplenism or painful splenomegaly, splenectomy can be a useful measure [2,6,9,13,16,17]. Some authors also include portal hypertension secondary to splenomegaly among the indications for splenectomy in IM [5,7,12], It must be pointed out, however, that the influ ence of splenectomy on both the disease evolution and the patients' survival is not clear.…”

Splenectomy; Postoperative Splenectomy Complications

“…Literature shows post splenectomy complications rate ranging from 12% to 52% while mortality rates ranging from 1% to 9%. For example, Musser et al 12 reported a complication rate of 25% and mortality rate of 5%, Dawson et al 13 reported a morbidity of 25%, and mortality of 1%, Similarly, Johansson et al 14 described various complications in 14.5% patients with mortality of 1%. Recent studies show more favorable results, like Kojouri et al, in an analysis of 3386 splenectomies, reported a complication rate of 9·6% for laparoscopic splenectomy and 12·9% for open splenectomy, while associated mortality rates were very low, at 0·2% and 1% respectively.…”

The implications for patients undergoing splenectomy: postsurgery risk management

“…[1][2][3] Splenectomy has been performed for a heterogeneous group of hematologic diseases with a therapeutic or diagnostic purpose or as part of the staging process in Hodgkin's disease. Splenectomy has proved to be safe and effective in selected patients presenting non-Hodgkin's lymphoma, idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura, and hairy cell leukemia.…”

“…Several retrospective studies of splenectomy for hematologic disease show complication rates that range between 13% and 52%, with mortality rates ranging from 1% to 9%. 1,4,8,9 Musser et al 1 reported a complication rate of 25% and a 5% mortality rate in 306 splenectomies performed at the University of California, Los Angeles, with 19% of the procedures performed for diagnostic reasons only. The authors also acknowledge that significantly fewer complications were observed in patients undergoing diagnostic splenectomy.…”