RISKS AND BENEFITS OF SPLENECTOMY IN MYELOFIBROSIS - AN ANALYSIS OF 39 CASES

From 1980 to 1993, 39 splenectomies were performed in the Department o f Visceral Surgery of Saint-Louis Hospital, in patients referred for m yelofibrosis associated with myeloid splenomegaly. The short term morb idity was considerable: 33 serious haemorrhagic, infectious or thrombo tic complications including 5 fatal accidents were observed in 18 pati ents. Severe thrombotic or infectious complications leading to 6 furth er deaths occurred in 8 patients over the two years following splenect omy, while six cases of acute leukaemia appeared between 6 months and 3 years after splenectomy. In 40% of cases with regular follow-up, the operation did not provide any haematological improvement and all thes e patients died. Only patients with minimally progressive or stable my elofibrosis and residual marrow activity in isotope studies showed an amelioration of general status with relief of pain and reduction of tr ansfusional requirements. The indication for splenectomy should theref ore probably be limited to such cases.