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Splenectomy in Patients with Hematological Disorders - Our Experience

100%
Żukrowski P., Kielan W., Grzebieniak Z., Rudnicki J., Tarnawa R., Agrawal A., Bąk T., Knakiewicz M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 6
426-435
EN
The aim of the study. Retrospective analysis of indications for splenectomy in hematological diseases, positive effect of this operation and correlations between objective prognostic factors and good response to splenectomy in patients with different hematological indications for splenectomy.Material and methods. 98 adult patients with hematological disorders, who were splenectomised in the years 1994 - 2004. We evaluated the effects of splenectomy in patients with hematological diseases as defined by patient documentation from the 2nd Department of General and Oncological Surgery, Department of Hematology and Hematological Ambulance and the questionnaires that patients completed by themselves.Results. The beneficial effect of splenectomy was observed in the majority of cases of idiopathic thrombocytopenic purpura (41 of 53 patients), acquired hemolytic anemia (2 of 3 patients) and hereditary spherocytosis (8 of 9 patients). Surgery can provide a high frequency of durable response for adult patients with benign hematological disorders. In malignant hematological diseases, splenectomy eliminates consequences of hypersplenism or splenomegaly. Splenectomy in patients with malignant hematological disorders can improve their condition and relieve symptoms of hypersplenism and splenomegaly to improve their quality of life. There were early complications in 11 patients (11.3%). Mortality was 2%. Late complications appeared in 24 patients out of 96 patients, who survived the perioperative period. The most common late complication was moderate respiratory infections.Conclusions. Splenectomy is the most common operation in patients with hematological disorders. Indications for splenectomy have been hindered by the lack of any objective prognostic factors of good postoperative response. Nevertheless, the effect of splenectomy is positive in many patients with benign and malignant hematological diseases.
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Analysis of Selected Clinical and Laboratory Parameters in Patients with Splenectomy Complications Due to Hematological Disorders

80%
Żukrowski P., Kielan W., Grzebieniak Z., Rudnicki J., Tarnawa R., Agrawal A., Bąk T., Knakiewicz M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 6
418-425
EN
The aim of the study was to investigate the role of certain clinical characteristics and laboratory examination results as prognostic factors for complications after splenectomy in patients with hematological disorders.Material and methods. Ninety-eight adult patients with hematological disorders who underwent splenectomy in our department between years of 1994 and 2004. A retrospective analysis of the medical records from patients who underwent splenectomy was conducted; we divided the patients into 6 groups with various postoperative complications; patients without complications after splenectomy were the control group (the seventh group). Then, we compared patients from groups 1 - 6 with patients from the control group (group 7) before and after splenectomy with regard to various parameters including age, sex, presence of splenomegaly or accessory spleen, the operation's duration, hemoglobin level, number of erythrocytes, leukocytes and plateletes, levels of protein and fibrinogen, activity of prothrombin, INR, APTT, TT, proteinogram and levels of IgG, IgM and IgA.Results. We found that postoperative complications, especially early complications, were more common in groups with malignant hematological complications and in older patients. Infection complications appear more often in men than in women with benign hematological disorders. The sustained platelet level elevation after splenectomy is positively associated with a higher number of thrombotic complications. Also, a lower level of gamma globulin, IgG and IgM after splenectomy correlated with a higher number of infection complications.Conclusions. Splenectomy in patients with hematological disorders is burdened with small risks of postoperative complications. Some clinical and laboratory parameters can be used to select the group of patients with higher risks of complications, but there remains a lack of objective prognostic factors which are sure in every clinical situation.
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Accesory Spleen - Incidence, Localization and Clinical Significance

80%
Arkuszewski P., Srebrzyński A., Niedziałek L., Kuzdak K.
Polish Journal of Surgery
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2010
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vol. 82
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issue 9
510-514
EN
The aim of the study. Assesment of prevalence, localization and clinical significance of an accessory spleen in own research material.Material and methods. Retrospective analysis of medical records of 8 patients managed in the Department of Endocrine and General Surgery of Medical University of Łódź between 1st January 2006 and 31st December 2009 with an accessory spleen recognized in the perioperative period. 7 splenectomies were performed (5 due to hematological indications) while one patient was operated on due to the recurrence of hematological disorders after previous splenectomy 3 years earlier.Results. In the early postoperative period complications requiring surgical reintervention occured in 2 patients. 5 patients underwent splenectomy for hematological indications and in 4 of them parameters of complete blood count improved. In one female patient operated on due to idiopathic thrombocytopenic purpura postoperative thrombocytopenia occured after splenectomy and excision of an accessory spleen.Conclusions. An accessory spleen is identified during 10% of splenectomies. This anomaly is most often localized in the area of vascular splenic hilum and is usually single. Complications after excision of the accessory spleen are attributable to splenectomy and typical for this procedure. The presence of the accessory spleen is significant only when excision of entire splenic tissue is necessary due to hematological indications.
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Ruptured Splenic Artery Aneurysm (Saa) as a Complication of Acute Pancreatitis – Case Report

80%
Janczak D., Fiktus A., Pawłowski L., Jaźwiec P., Chabowski M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 10
551-554
EN
The study presented a case of a 29 year-old male patient with a pseudoaneurysm of the splenic artery as a complication of acute pancreatitis. The pseudoaneurysm was incidentally diagnosed during control angio-CT. The patient underwent immediate surgery due to deterioration of his clinical condition. During laparotomy the pseudoaneurysm, spleen and part of the pancreatic tail were excised. The postoperative course proved uneventful and the patient was discharged from the hospital after seven days.
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Splenic abcesses as infectious complication following implantation of left ventricular asssist device - case report

80%
Gajda S., Szczepanik A. M., Religa G., Misiak A., Szczepanik A. B.
Polish Journal of Surgery
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2017
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vol. 89(1)
61-65
EN
Left ventricular assist device (LVAD) is one of the modern management therapies in patients with advanced heart failure, and it serves as a bridge to heart transplantation or even as destination therapy. However, it is burdened with a high risk of thromboembolic, hemorrhagic, and infectious complications despite prophylactic management. Splenic abscesses, as septic complications following implantation of mechanical ventricular support, have not yet been described in the literature. We report of a patient with severe left ventricular insufficiency (NYHA II/III), pulmonary hypertension, and arrhythmia who underwent implantation of the Heart Ware® pump for left ventricular support with simultaneous tricuspidvalvoplasty, as a bridge therapy to heart transplantation. During two years after LVAD implantation, the patient had three MRSA skin infections, localized at the exit site of the drive-line connecting the artificial ventricle with external unit, that were complicated by sepsis and treated with broad-spectrum antibiotics. A few months later, abdominal CT revealed two abscesses in the spleen, and the patient was qualified for splenectomy. Open splenectomy was performed under full-dose anticoagulant therapy with continuous intravenous infusions of unfractionated heparin (UFH). The intra- and postoperative course was uneventful. UFH therapy was continued for 6 days, and oral anticoagulation was re-administered on day 4 after surgery. The patient was discharged on day 7 after surgery with primary healed wound. Open splenectomy, performed with full-dose anticoagulant therapy, proved to be an effective and definitive method of treatment without any complications.
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Surgeons' and Hematologists' Decisions on Splenectomy in the Treatment of Congenital Spherocytosis

80%
Dadan J., Róg M., Wojskowicz P., Iwacewicz P., Safiejko K., Jaromin J., Róg-Makal M., Puchalski Z.
Polish Journal of Surgery
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2008
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vol. 80
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issue 3
146-152
EN
The aim of the study was to present and discuss the results of surgical treatment of congenital spherocytois in our department.Material and methods. Between 1994 and 2001 in the Department of General and Endocrinological Surgery at the Medical University in Białystok, 14 surgical excisions of enlarged spleens were performed because of congenital spherocytosis. The patients included five men and nine women aged between 17 and 61.Results. Diagnosis; non-surgical treatment and principles governing the decicion to use surgical intervention were evaluated by the Department of Hematology. Histopathological examinations for all cases confirmed the diagnosis of congenital spherocytosis.Conclusions. The undertaking of carefully considered procedures by the surgeons and hematologists in our departments resulted in propitious results in all the cases presented.
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Laparoscopic splenectomy and porto-azygos disconnection: clinical research in the treatment of portal hypertension

70%
Fengyong W., Yuanshui S., Zhangbing, Yuewu W., Weihua Z., Jianfeng S., Qi W., Jinming L., Ji X., Zaiyuan Y.
Open Medicine
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2014
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vol. 10
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issue 1
EN
To investigate the safety and efficacy of laparoscopic splenectomy and portaazygous devascularization, we studied laparoscopic splenectomy and porto-azygos devascularization patients within the peri-operative period. Clinical data and curative effect are detailed alongside statistical analysis. The laparoscopic splenectomy and porto-azygos devascularization operation time was 2.56 + 0.62 hours. The intraoperative bleeding and anal exhaust time was 149.5 + 32.7ml 3.47 + 1.32 days, and the hospitalization time was 5.05 + 1.22 days. When the spleen volume was greater than or equal to 1.5 liters, the rate of open abdominal surgery increased significantly. After 1, 2, 3, and 4 years of follow-up, cumulative recurrence bleeding rates were 0, 5.20%, 9.98%, and 15.83%, respectively. Laparoscopic splenectomy and pericardial devascularization is safe, effective, and feasible, and it can be confirmed by enhanced spiral computed tomography (CT). Whether spleen volume greater than 1.5L is suited to laparoscopic surgery requires further research.
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Morbidity, Mortality and Survival after Stomach Resection with or without Splenectomy – The Single Centre Observations

70%
Stojcev Z., Bobowicz M., Jarząb M., Pawłowska-Stojcev T., Banasiewicz T.
Polish Journal of Surgery
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2013
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vol. 85
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issue 8
433-437
EN
Over the last decade, gastric cancer treatment has changed from extensive multiorgan resections towards less invasive approaches with limited resections and a more selective lymphadenectomy. Despite all available trials, the conclusions on the extent of necessary resections still remain debatable. The aim of the study was to assess the short term outcomes (morbidity and mortality) of a total gastrectomy depending on the simultaneous splenectomy status. Material and methods. We performed a retrospective analysis of the records of all patients treated with a curative intent using a total gastrectomy for gastric cancer between 1997 and 2003. 49 patients fulfilled the inclusion criteria. Patients were divided into two groups: S(+) gastrectomy with splenectomy group (29 patients) and S(-) total gastrectomy with spleen preservation (20 patients). Results. Survival analysis at one year showed that there was no difference in survival between the two groups (p=0.84). There were six recurrences, one in the group S(+) and five in group S(-) (p>0.05). Dissemination was observed in three patients in group S(-) (p>0.05). Other complications including infectious complications, exenteration, subileus, cardiovascular insufficiency, multiorgan failure were more frequent in the S(+) group (31% v 15%) although the difference was not significant (p=0.17). Conclusions. Splenectomy during gastrectomy for cancer has no statistically significant impact on short-term morbidity and mortality. Even though it does not show benefit in terms of 5-year overall survival rates it might be performed when needed in more advanced cases in properly selected patients (e.g. upper gastric T3/4 gastric cancer)
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Splenic Absces - Diagnostics and Treatment

70%
Bilski R., Szczepanik A., Wiszniewski A., Meissner A., Ratajczak J.
Polish Journal of Surgery
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2009
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vol. 81
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issue 9
392-399
EN
Splenic abscess is a rare condition often difficult to diagnose and always fatal, if untreated. It is frequently concomitant with immunodeficiency, especially in hematological disorders.The aim of the study was to share our own experience in the treatment of splenic abscess and to present the review of current literature on the subject.Material and methods. In the period January-June 1997, 8 patients were treated for splenic abscess at the Department of General and Hematological Surgery of the Institute of Hematology and Transfusion Medicine in Warsaw; (6 men and 2 women; mean age 51.3 years). Six patients reported immunodeficiency disorders in medical interview (immunoglobulin deficiency, alcoholism, leukopenia, agranulocytosis, lymphoproliferative disorders).Prior to operation, chest X-rays as well as US and CT imaging were performed for all patients; all were qualified for splenectomy.Results. In all cases, imaging studies revealed splenomegaly and characteristics suggestive of splenic abscess, in chest X-ray of 6 patients typical abscess changes were also found. Classic splenectomy was performed in all 6 cases. The total mass of spleen removed was 365 g-1560 g, mean of 962 g. Procedure duration was 72 to 135 min, mean of 88,3 min. Patients were transfused 1 to 4 units of red blood cell concentrate, mean of 2.1 units. In patients with perisplenitis, priooperative blood loss was greater and the procedure was extended. In the postoperative period, such complications as deep vein thrombosis of lower extremities, portal vein thrombosis, aggrevation of chronic renal insufficiency and circulatory insufficiency evoked by paroxysmal atrial fibrillation were observed in 4 patients. No deaths were reported. Six patients were discharged in a satisfactory state; 2 were transferred to the hematological department for further treatment due to persisting septic state.Conclusion. Despite a high incidence rate of periooperative complications, classic splenectomy still remains the procedure of choice for splenic abscess treatment.
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The Influence of Splenectomy Performed Simultaneously with Gastrectomy on Postoperative Complications in Patients with Gastric Cancer Undergoing Surgery with the Intention to Treat

70%
Głuszek S., Kot M., Kuchinka J., Matykiewicz J.
Polish Journal of Surgery
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2015
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vol. 86
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issue 7
312-318
EN
Despite the growing understanding of the pathophysiological processes in the perioperative period and significant advancements in surgical techniques, operative treatment for gastric cancer remains a challenge for surgeons, especially because the primary procedure of total or nearly total gastrectomy must at times be extended by the resection of other organs. The aim of the study was to asses the influence of concomitant splenectomy in patients undergoing curative surgery for gastric cancer on postoperative complications. Material and methods. The study population consisted of 258 patients who underwent surgical treatment for gastric cancer with the intention to treat. The study assessed the influence of extending the surgical intervention by splenectomy on postoperative complications, both general and surgical, including the most severe of these, i.e. oesophago-gastric anastomotic leakage, duodenal stump leakage and peritoneal fluid infections. Results. Among the 258 gastric cancer patients receiving curative surgical treatment, the most common simultaneous intervention was splenectomy: 42/258 (16.3%), which was also accompanied by partial pancreatectomy in 8 cases. The number of surgical postoperative complications, major and minor, was similar in both subgroups: with and without splenectomy. Minor general complications, such as pyrexia with no clinically apparent reason, atelectasis, pneumonia and pleural effusion were statistically significantly more common in the subgroup with splenectomy (p=0.0001). Conclusion. Splenectomy performed concomitantly with gastrectomy for gastric cancer increases the risk of minor general complications. However, it does not increase the risk of severe surgical complications, such as oesophago-intestinal anastomotic leakage and does not increase the risk of death
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Pancreatic Tail Cysts

61%
Stefański L., Lampe P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 6
310-314
EN
The aim of the study was to determine the optimal surgical strategy in patients with pancreatic tail cysts infiltrating the spleen, stomach, left diaphragmatic dome, or transverse colon mesentery.Material and methods. From 1997 through 2004, 184 patients with pancreatic pseudocysts were evaluated and treated in our Department. In 63 of those cases (34.2%), the lesion was located in the tail of the pancreas, and was classified as type II or III according to D. Egidio and Schein.Results. Combined pancreatic tail and splenic resection was performed in 32 subjects (51%), 13 (20%) underwent external drainage / marsupialisation, 11 (18%) had a Roux-en-Y pancreaticocystojejunostomy, and one patient underwent a Duval operation. Endoscopic drainage to the stomach (pancreatocysto-gastrostomy) was used in one subject; another five patients who had previously undergone external drainage / marsupialisation and developed a recurrent cyst within four months after the primary procedure were selected for pancreaticocystojejunostomy. Thus, internal drainage was performed in a total of 18 patients (28%).Conclusions. Based on our experience, we prefer pancreatic tail resection (with splenectomy) in those patients who present to the hospital with involvement of the neighbouring organs.
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Ograniczenia w leczeniu chirurgicznym raka jajnika

51%
Makarewicz M., Koper K., Śpiewankiewicz B., Budzyński A., Rajs T., Kojs Z., Bieda T., Wicherek Ł.
Current Gynecologic Oncology
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2014
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vol. 12
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issue 2
140-154
EN
Removal of all foci of ovarian carcinoma during the first surgery considerably improves overall survival. Obtaining complete cytoreduction is not, however, possible in each case. When the procedure is performed in a referral center, complete cytoreduction is obtained in as many as 75–90% of patients. A lot of recent studies indicate that experience of the physician who performs the first procedure affects the degree of cytoreduction. Moreover, the experience of the center in which treatment is started also influences overall survival. Therefore, one might contribute to the improvement of the therapy outcome by refining one’s surgical skills. The experience of a surgeon is essential in resecting metastatic foci in sites such as the hepatoduodenal ligament, omental foramen, splenic recess of the peritoneum, superior omental recess, splenic hilum, tail of the pancreas as well as areas of the diaphragmatic and renal vessels. For a procedure to be effective, it must involve the entire peritoneum with all its recesses. The essential elements of the procedure which decide about the degree of cytoreduction are: 1) removing the rectum and peritoneum of the lower recess (modified posterior exenteration); 2) resection of the ovarian vessels and para-aortic lymphadenectomy; 3) removing the peritoneum of the diaphragm and partial resection of the diaphragm; 4) fragmentary resection of the gastrointestinal tract; 5) splenectomy with resection of foci in the lesser sac. The paper presents anatomic limitations that affect surgical treatment of ovarian carcinoma in these regions.
PL
Usunięcie wszystkich ognisk raka jajnika w czasie pierwszej operacji wydłuża znamiennie całkowite przeżycie. Doprowadzenie do całkowitej cytoredukcji nie jest jednak możliwe w każdym przypadku. Gdy zabieg przeprowadza się w ośrodku referencyjnym, całkowita cytoredukcja osiągana jest nawet u 75–90% operowanych chorych. Wiele ostatnich badań wskazuje, że o stopniu cytoredukcji decyduje doświadczenie lekarza, który wykonał pierwszą operację. Istotne dla całkowitego przeżycia jest także doświadczenie ośrodka, w którym rozpoczyna się leczenie. Dlatego dbając o warsztat chirurgiczny, można przyczynić się do poprawy wyników terapii. Doświadczenie chirurga jest niezbędne w resekcji ognisk przerzutowych w takich miejscach, jak więzadło wątrobowo-dwunastnicze, otwór sieciowy, zachyłek śledzionowy otrzewnej, zachyłek górny torby sieciowej, wnęka śledziony, ogon trzustki, okolice naczyń przeponowych i naczyń nerkowych. Aby zabieg zakończył się sukcesem, powinien dotyczyć całej otrzewnej i wszystkich jej zachyłków. Kluczowe elementy tej operacji, decydujące o stopniu cytoredukcji, to: 1) usunięcie odbytnicy i otrzewnej zachyłka dolnego (zmodyfikowane wytrzewienie tylne); 2) resekcja naczyń jajnikowych i limfadenektomia okołoaortalna; 3) usunięcie otrzewnej z przepony i częściowe resekcje przepony; 4) resekcje odcinkowe przewodu pokarmowego; 5) splenektomia wraz z resekcją ognisk z torby sieciowej. W pracy przedstawiono anatomiczne ograniczenia wpływające na przebieg leczenia chirurgicznego raka jajnika w tych obszarach.
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Rola splenektomii w chirurgicznym leczeniu raka jajnika

51%
Opławski M., Kojs Z., Bieda T.
Current Gynecologic Oncology
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2013
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vol. 11
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issue 3
210-216
EN
In the treatment of ovarian cancer, surgery, chemotherapy or possibly radiotherapy are applied. The scope of sur­gery is the most significant prognostic factor. Complete cytoreduction is the optimal surgical method. Most fre­quently, ovarian carcinoma does not involve only the reproductive system, but spreads throughout the peritoneal cavity. In some cases, splenic involvement is found during a surgery. In such cases the surgery should be supple­mented with splenectomy – when the spleen is removed as an additional procedure during the operation or as an element of the en bloc removal of the tumor along with the omentum, colon and gastrocolic ligament. Such an extended operation results in only slightly increased number of complications and has no significant impact on the quality of life of ovarian cancer patients. It often enables full cytoreduction. Complications of this part of the oper­ation predominantly include hemorrhage, thromboembolism, infection and, in the case of en bloc operation, anas­tomotic separation within the gastrointestinal tract. The data available report increased number of intraoperative blood transfusions. The procedure in question is most frequently carried out during a secondary cytoreductive sur­gery. Despite the lack of recommendations, such procedures should be performed by a surgical team experienced in operations in the upper abdominal cavity. The treatment should be complemented with state-of-the-art chemo­therapy. This kind of treatment requires establishing a national network of oncological centers dealing with com­bined therapies of malignant neoplasms.
PL
W terapii raka jajnika stosuje się leczenie chirurgiczne, chemioterapię i, ewentualnie, radioterapię. Zakres leczenia operacyjnego stanowi najistotniejszy czynnik prognostyczny. Całkowita cytoredukcja jest optymalną opcją lecze­nia chirurgicznego. Rak jajnika najczęściej dotyczy nie tylko narządu rodnego, ale również jamy otrzewnej. U nie­których chorych podczas zabiegów stwierdzane są przerzuty do śledziony. W takich przypadkach procedura chi­rurgiczna powinna być uzupełniona o wycięcie śledziony, która jest usuwana dodatkowo w trakcie zabiegu lub jako element operacji en bloc guza wraz z siecią, okrężnicą i więzadłem żołądkowo-okrężniczym. Takie poszerzenie zabiegu powoduje tylko nieznaczne zwiększenie liczby powikłań i nie wpływa znacząco na jakość życia chorych. Zabieg ten często umożliwia uzyskanie pełnej cytoredukcji. Do powikłań tej części zabiegu należą głównie powikła­nia krwotoczne, zakrzepowo-zatorowe, infekcje oraz w przypadkach operacji en bloc – rozejścia zespoleń w ukła­dzie pokarmowym. Dostępne dane wskazują na zwiększoną liczbę śródoperacyjnych przetoczeń krwi. Zazwyczaj zabieg ten jest wykonywany podczas wtórnej operacji cytoredukcyjnej. Pomimo braku takich zaleceń operację po­winien wykonywać zespół doświadczony w przeprowadzaniu zabiegów w górnym piętrze jamy brzusznej. Lecze­nie należy uzupełnić o nowoczesną chemioterapię. Taki model postępowania wymaga utworzenia ogólnokrajowej sieci ośrodków onkologicznych, zajmujących się leczeniem skojarzonym nowotworów złośliwych.
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