SPLENECTOMY FOR HEMATOLOGICAL DISEASES - A SINGLE INSTITUTION EXPERIENCE

Objectives: To evaluate our experience with splenectomy for haematolog ical diseases over 15 years, focusing on the diseases and indications requiring surgery, the complications and the haematological results. D esign: A single institution retrospective analysis. Setting: Departmen ts of Surgery, Internal Medicine and Haematology, Rabin Medical Center , Hasharon Hospital, Petah-Tikva, Israel. Patients: Sixty-nine patient s undergoing splenectomy for haematological diseases between 1980 and 1994. Parameters studied: (1) the patient characteristics; (2) the hae matological disorders and the indications for splenectomy; (3) the spl enic size; (4) perioperative complications; (5) the haematological and other results of surgery. Results: The common disease requiring splen ectomy in our patient population was immune thrombocytopenic purpura ( ITP). Eighteen patients (26%) suffered from ITP, 12 (17.4%) had lympho proliferative (LP) disorders, including 11 patients with non-Hodgkin's lymphoma (NHL), 9 (13%) immune haemolytic anaemia (IHA), 8 (11.6%) Ho dgkin's disease (HD), and 8 patients with myeloproliferative diseases (MPD). Fifty-two patients (75.4%) underwent surgery for therapeutic pu rposes while 25 patients (36.2%) underwent diagnostic surgery. Eight p atients were operated on for both indications. Patients with HD and IT P were younger (mean age in the 30th year) as opposed to patients with congestive splenomegaly and LP (mean age in the 60th year). Most pati ents with ITP, NHL and MA were female. Patients with HD and ITP had a small spleen (< 300 g), in contrast with HCL and MPD (> 2400 g). No pe rioperative mortality was observed. Twenty-one patients (30.4%) experi enced perioperative complications, including bleeding in 9 patients (1 3%) and infection in 10 patients (14.5%). Of the 34 patients evaluable for platelet response to splenectomy, 26 (76.5%) achieved complete re sponse (CR), including 15 of 18 patients with ITP. Eleven of the 17 (6 4.7%) anaemic patients evaluable for haemoglobin (Hb) response achieve d CR. Eight of the 9 leucopenic patients obtained CR. In 15 patients, splenectomy established the diagnosis, including 8 patients with NHL. In 2 others, surgery confirmed the tentative diagnosis. In 2 of the 8 HD patients the spleen was found to be involved. Conclusions: From bot h therapeutic and diagnostic standpoints splenectomy is a relatively s afe and effective procedure. However, no long-term follow-up data are provided to allow conclusions regarding the long-term prognosis of dis eases such as myelo- or lymphoproliferative disorders.