Laparoscopic Splenectomy for Splenomegaly:Long Term Follow up of 61 patients

Background: Numerous studies have demonstrated the feasibility of laparoscopic splenectomy(LS) for splenomegaly. There is little published data on the efficacy of LS for the treatment of splenomegaly associated cytopenias. The aim of this study is to determine long-term outcomes following LS for splenomegaly.

Methods: Retrospective review of patients undergoing LS between 8/95 and 5/05. Splenomegaly was defined by CT criteria of craniocaudal length > 17 cm. Preoperative diagnoses included lymphoma in 13 patients (20%), leukemia in 15 (23%), autoimmune hemolytic anemia in 3 (5%) and other hematologic disorders in 8 (12%). Twenty-six patients (40%) had no definitive diagnosis prior to splenectomy. Patients with ITP were excluded. Patient demographics, operative indications, operative morbidity and mortality, pathology, pre- and postoperative hematological indices were collected. Follow-up data was collected from patient records and telephone interviews.

Results: 311 patients underwent LS during the study period. 65 patients underwent LS for splenomegaly. The mean age of the study group is 59. 62% were male. There were no operative mortalities. 7 patients(11%) were converted from LS to open. There were 9(14%) major complications including 4 re-operations (3 for bleeding), 3 portal vein thromboses, 1 intra-abdominal abscess and 1 postoperative hemorrhage managed non-operatively. 32 patients underwent LS primarily for diagnostic purposes. 9 patients had an existing hematological diagnosis and LS was performed to evaluate splenic involvement. LS confirmed a diagnosis in 19 (59%) patients including 11 lymphomas (34%). Thirty-three patients underwent LS primarily for treatment of either symptoms (11) or cytopenias (22). LS effectively treated mass symptoms in all patients. Among all patients 33(51%) had associated cytopenias. At median f/u of 20 months(1-86) 15 (45%) patients had no recurrence of cytopenias, 15(45%) patients required further treatment and 3 were lost to follow up. One responder (7%) died of lymphoma 3 months after surgery without recurrence of cytopenia. The 15 non-responders had progression of disease requiring chemotherapy and transfusions and 9 (60%) died a median of 6 months after splenectomy.

Conclusion: LS is effective for alleviation of mass related symptoms of splenomegaly and is a valuable diagnostic tool. It is less effective as isolated treatment of cytopenias related to hematological malignancies.

Session: Podium Presentation

Program Number: S058

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