Our Summary

This study looked at how effective a certain type of surgery, called laparoscopic splenectomy (LS), is for treating blood diseases that affect the spleen. LS is a procedure where doctors remove the spleen through a few small cuts in the abdomen, instead of one large cut. This is the preferred method for treating non-cancerous diseases of the spleen. However, it’s not clear whether LS is as effective for treating spleen diseases that are cancerous. This might be because the surgery is technically difficult, can cause severe bleeding, and requires the identification of the cancer cells in the spleen.

The researchers looked at the outcomes of 145 patients who had LS for spleen diseases. They divided these patients into two groups: Group A, with 83 patients who had non-cancerous diseases, and Group B, with 62 patients who had cancerous diseases. They examined several outcomes, such as the size of the spleen, the length of the operation, the need to convert to a more traditional surgery, complications, and the need for blood transfusions.

They found that the spleens were larger in the cancer group, and these patients had more mini-laparotomies (small additional cuts to assist the surgery), and were more often required to convert to traditional surgery. The surgeries also took longer in the cancer group. However, there was no significant difference between the two groups in terms of needing blood transfusions or experiencing complications after surgery. No patients died during the study period.

These findings suggest that LS is a viable and safe option for treating blood diseases of the spleen, including cancerous ones, even though the surgery may be more challenging and take longer in these cases. However, patients with cancerous diseases may be more likely to need additional procedures or a conversion to traditional surgery.

FAQs

  1. Is laparoscopic splenectomy (LS) a recommended treatment for hematologic malignancies?
  2. What were the primary findings of the study on patients who underwent LS for hematologic diseases?
  3. Does the size of the spleen affect the outcome of the laparoscopic splenectomy in patients with hematologic malignancies?

Doctor’s Tip

A doctor may recommend that a patient undergoing splenectomy for hematologic malignancies be aware that there may be a higher risk of conversion to open surgery due to splenomegaly and difficult dissection of the spleen hilum. However, overall, laparoscopic splenectomy is still considered a safe and effective procedure for treating hematologic malignancies of the spleen. It is important for the patient to follow postoperative care instructions and attend follow-up appointments to monitor their recovery.

Suitable For

Patients with hematologic malignancies are typically recommended splenectomy if they have a preoperative diagnosis of a malignant disease of the spleen. However, it is important to consider the technical difficulties, hemorrhagic risk, and the need for pathological characterization of the disease before proceeding with a laparoscopic splenectomy. Patients with splenomegaly and difficult hilum dissection may have a higher conversion rate to open surgery, but overall, laparoscopic splenectomy is considered safe and effective in the treatment of hematologic malignancies of the spleen.

Timeline

Before splenectomy:

  1. Patient is diagnosed with a hematologic disease or malignancy affecting the spleen.
  2. Patient undergoes preoperative evaluation and imaging studies to assess the size and condition of the spleen.
  3. Surgical team determines if laparoscopic splenectomy is appropriate based on the diagnosis and patient’s overall health.
  4. Patient may undergo preoperative blood transfusions or other treatments to prepare for surgery.

After splenectomy:

  1. Patient undergoes laparoscopic splenectomy procedure, which typically takes around 2-3 hours.
  2. In cases of malignancies, the removed spleen is sent for pathological analysis to confirm the diagnosis.
  3. Patient may experience postoperative pain, fatigue, and discomfort, which can be managed with pain medications and rest.
  4. Patient is monitored for any complications such as bleeding, infection, or blood clots.
  5. Patient is gradually able to resume normal activities and diet as they recover from surgery.
  6. Patient may be prescribed antibiotics or vaccines to prevent infections, as the spleen plays a role in the immune system.
  7. Long-term follow-up is necessary to monitor for any potential complications or changes in the patient’s health.

What to Ask Your Doctor

  1. What is the reason for recommending a splenectomy for my hematologic condition?
  2. Are there any alternative treatment options to consider before undergoing a splenectomy?
  3. What are the potential risks and complications associated with a splenectomy for hematologic malignancies?
  4. How experienced are you in performing laparoscopic splenectomies for hematologic malignancies?
  5. What is the expected recovery time and postoperative care plan following a splenectomy?
  6. Will I need any additional testing or monitoring after the splenectomy to ensure the success of the procedure?
  7. Are there any specific dietary or lifestyle changes I should make after a splenectomy?
  8. How will the removal of my spleen impact my immune system and overall health in the long term?
  9. Will I need any vaccinations or medications to prevent infections after the spleen removal?
  10. Are there any support groups or resources available for patients undergoing a splenectomy for hematologic malignancies?

Reference

Authors: Serra F, Roli I, Campanelli M, Cabry F, Baschieri F, Romano F, Gelmini R. Journal: Minerva Chir. 2019 Oct;74(5):365-373. doi: 10.23736/S0026-4733.19.07851-9. Epub 2019 May 2. PMID: 31062942