Richard A Perugini, MD, Jan Cerny, MD, Muthalagu Ramanathan, MD. University of Massachusetts Memorial
Introduction: Massive splenomegaly is common in myelofibrosis with myeloid metaplasia (MMM). Splenectomy via laparotomy has been performed for MMM since 1937, and fell out of favor due to a high rate of perioperative morbidity, with no survival benefit. The utility of splenectomy for MMM is being explored again. Stem cell transplant (SCT) now offers the possibility for cure of MMM; patients who undergo splenectomy have a faster hematopoietic recovery after SCT. In addition, laparoscopic techniques offer the possibility of lower perioperative morbidity. Our aim was to evaluate perioperative complications and long term survival among patients with MMM who underwent a laparoscopic splenectomy in preparation for SCT.
Methods and Procedures: This is a series of patients with MMM and massive splenomegaly treated at an academic tertiary care hospital from 2012 to 2016. All underwent laparoscopic splenectomy in preperation for SCT. The main outcome measures were survival, perioperative complication rate, and postoperative length of stay. Survival was predicted prior to surgery using the Dynamic International Prognostic Scoring System (DIPSS plus).
Results: Eight patients (4 male) with a median age of 69 (range 34-81) underwent laparoscopic splenectomy. Hematologic abnormalities were common, and included leukopenia (4/8), leukocytosis (2/8), thrombocytopenia (7/8), and anemia (7/8). The median spleen size was 900 g (range 300-6620g). Five of eight patients had complications, including deep venous thrombosis, atrial fibrillation, superficial wound infection, colitis, hemorrhage and pneumonia. One mortality resulted from respiratory failure due to leukemic transformation. The median hospital length of stay was 5 days (range from 3-40 days). Six subjects have undergone SCT a median of 83 days following splenectomy. The Kaplan Meier probability of survival following splenectomy is 65% at three years and 33% at five years, which compares favorably with the DIPSS predicted survival (median 16 mos).
Conclusions: Laparoscopic splenectomy for individuals with MMM may allow the procedure to be performed more easily, and with lower rate of intraoperative complications. However, post-operative complications of hemorrhage, thrombosis and infection are still common; these are likely related to the disease process. Although perioperative morbidity is high, splenectomy followed by SCT does appear to offer a better prospect for long term survival.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80092
Program Number: P709
Presentation Session: Poster (Non CME)
Presentation Type: Poster