SPLENECTOMY AS PART OF CYTOREDUCTIVE SURGERY FOR OVARIAN-CARCINOMA

Splenectomy is sometimes necessary to achieve optimal cytoreduction or manage iatrogenic injury in the surgical management of epithelial ova rian cancer (EOC) and related conditions. To determine the place of sp lenectomy in cytoreductive surgery a retrospective review was made of patient hospital records. Between April 1989 and August 1994, 18 patie nts were found to have undergone a splenectomy as a component of their surgery leading to optimal debulking, Morbidity attributable to the s plenectomy was minimal, with no significant increase in operative time or blood loss. The morbidity attributable to the splenectomy was as f ollows: atelectasis and/or effusion (8), pancreatic tail injury (4), t hrombocytosis > 10(6)/mu l (3), pancreatic pseudocyst (1), partial lef t adrenalectomy (1), and pulmonary embolism (1). There were no instanc es of overwhelming postsplenectomy infection. Five patients were antic ipated to require splenectomy and may have benefitted from preoperativ e vaccination against potential pathogens. Three patients were found t o have splenic parenchymal metastases. Consistent with the internation al literature, these patients had other features consistent with stage IV disease, recurrent disease, or poor survival. Consideration should be given to expanding the FIGO stage IV classification to include spl enic parenchymal disease. Splenectomy is a feasible and safe procedure to facilitate optimal tumor debulking; however, the potential associa ted morbidity mitigates against this procedure if significant, subopti mal residual disease is left elsewhere. (C) 1995 Academic Press, Inc.