Splenectomy in Myeloid Metaplasia

Abstract

A retrospective review of 19 patients with documented myeloid metaplasia undergoing, elective splenectomy during the past ten years at the Peter Bent Brigham Hospital is presented. The primary indications for splenectomy in 17 of these 19 were either hypersplenism or symptomatic splenomegaly. Eighteen of the 19 underwent both 59Fe-ferrokinetic studies and 51Cr-sequestration studies or, alternatively, 111In-marrow scintigraphy as a part of their routine preoperative evaluation. The death from sepsis of one patient six weeks post-operatively, whose marrow function was poor and whose level of splenic sequestration was minimal, confirms the efficacy of these studies in the preoperative prediction of hematologic response to splenectomy. Eighteen of the 19 patients benefited from the operation in terms of symptomatic relief and/or hematologic improvement, although surgery presumably did nothing to prolong survival in these patients. We conclude that splenectomy is indicated as a palliative maneuver for carefully selected patients with myeloid metaplasia without prohibitive operative risk, provided the criteria for selection of patients are adhered to and the surgeon and hematologist work together as a team.

Liver Dysfunction following Splenectomy in Idiopathic Myelofibrosis: A Study of 10 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. Thus, although some authors have reported a survival advantage for splenectomized IM patients [5], in a recent review, Ben-bassat et al [19] considered that splenectomy would prolong the survival of patients with thrombo cytopenia exclusively.…”

The choice between splenectomy and medical treatment in patients with advanced agnogenic myeloid metaplasia

“…Most reported causes of death in medically treated patients with AMM, thromboembolism (35%), leukemia (25%), and infections (15%) [24], are not likely to be averted by splenectomy . Therefore, the assumption that splenectomy does not prolong survival in AMM is the one most congruent with our current understanding of the natural course of the disease and with published subjective estimates [5,9,11,15]. This assumption reduces the choice of treatment of advanced AMM to the question: Is it better to continue living with painful splenomegaly , repeated transfusions or ascites, or to accept a defined risk of operative death in order to achieve a defined chance of relief?…”

“…Some authorities have recommended the operation for every patient immediately after diagnosis of AMM [6], others, for selected patients [3][4][5]8,9,15], and still other authors consider splenectomy as a palliative procedure to be used only in exceptional cases [ a very tentative and uncertain estimate of the expected benefits of splenectomy in AMM in terms of symptom relief and survival. Mortality and morbidity after splenectomy in AMM have been repeatedly found to be higher than those after splenectomy for other hematological disorders [ 1,2,4,11,12].…”

Late Postoperative Follow-Up of Patients Undergoing Subtotal Splenectomy

“…[23][24][25][26][27][28] Postoperative massive liver enlargement and rupture due to myeloid hepatomegaly, infections and bleeding are the most frequent complications of total splenectomy. 24,[26][27][28][29][30] Splenic artery ligation and partial splenectomy with preservation of the splenic pedicle are only palliative, since symptoms and splenic enlargement usually recur. [29][30][31][32][33] Preservation of the uppermost part of the spleen vascularized only by the splenogastric vessels maintains splenic function without enlargement of the organ.…”

“…24,[26][27][28][29][30] Splenic artery ligation and partial splenectomy with preservation of the splenic pedicle are only palliative, since symptoms and splenic enlargement usually recur. [29][30][31][32][33] Preservation of the uppermost part of the spleen vascularized only by the splenogastric vessels maintains splenic function without enlargement of the organ. 21,34 In trauma, the spleen is almost always normal and there is no reason to remove this important organ.…”