Mohamed O Mohamed, MBBS, Danuel V Laan, MD, Ahmad Nourallah, MD, Juliane BIngener. Mayo Clinic
INTRODUCTION: Laparoscopic splenectomy for patients with splenomegaly due to hematologic malignancy is a high-risk procedure performed to improve patients’ quality of life (QOL). A new grading score was recently published using age, gender, diagnosis and spleen weight to predict technical difficulties and complications after laparoscopic splenectomy. We wanted to validate the approach for patients with splenomegaly due to malignancy. Also, we hypothesized that patients reported outcomes (PRO) might be useful to estimate postoperative complications and aid patient and surgeon decision making for patients with splenomegaly due to hematological malignancies.
METHODS: Patients with splenomegaly (spleen weight >400g) due to a hematological malignancy who underwent elective splenectomy at our institution between 2008 and 2014 and had PRO measures available were identified retrospectively. Demographics, spleen weight, operative approach, preoperative QOL, pain and fatigue scores, the length of hospital stay (LOS), estimated blood loss (EBL) and complications were abstracted. Student t-tests and ANOVA were performed in intention to treat analysis.
RESULTS: Data of 101 patients with splenomegaly who had PROs available was analyzed. Mean age was 63 years,40 patients (31%) were women. Using the recent grading system, all patients in this data set were in the high-risk group. There was no 30-day mortality. Successful minimally invasive procedures were reported for spleens weighing less than 2540g (see Table1). Nine patients (22%) with splenomegaly required conversion from laparoscopic to open splenectomy; mean spleen weight 1625g(575-2540g). This group had the highest morbidity (22%) and EBL (886±872).
For the whole cohort; patients with higher preoperative fatigue (p-value0.013) and pain scores (p-value<0.001) had higher complications rate.
In patients undergoing laparoscopic splenectomy, preoperative pain predicted morbidity (p-value0.005) and LOS (p-value0.003). In patients undergoing open splenectomy preoperative pain and fatigue were predictors for complications.
Patients with a preoperative hemoglobin < 11 g/dL had LOS >7 days (p-value<0.001).
CONCLUSION: The recently published grading system did not add differentiating features to patients with splenomegaly for malignancy. Preoperative Patients Reported outcomes and preoperative anemia may be useful predictors of morbidity and LOS following laparoscopic and open splenectomy in patients with hematological malignancies.
| Laparoscopic(n=40) | HALS(n=15) | Open(n=46) | |
| Age(years)* | 64±12 | 67±14 | 62±11 |
| LOS(Days)* | 5.5±4.3 | 4.0±1.1 | 7.2±4.4 |
| Complications | 12.5% | 0% | 19.6% |
| EBL(ml)* | 451±521 | 248±209 | 570±743 |
| Spleen Weight(g)* | 1062(2540-400) | 1558(2535-705) | 2785(6210-710) |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80277
Program Number: P707
Presentation Session: Poster (Non CME)
Presentation Type: Poster
