SPLENECTOMY DURING PRIMARY AND SECONDARY CYTOREDUCTIVE SURGERY FOR EPITHELIAL OVARIAN-CARCINOMA

Splenectomy is occasionally indicated to achieve optimal cytoreduction during surgery for epithelial ovarian cancer. Between January 1989 an d December 1996, 40 epithelial ovarian cancer patients underwent splen ectomy: 14 patients during primary surgery and 26 during secondary cyt oreductive surgery. Splenectomy was performed for tumor reduction in 3 4 patients (85%) and for iatrogenic injury in six patients (15%). The spleen was removed because of parenchymal splenic metastases in nine p atients (22.5%), significant hilar and/or capsular disease in 10 patie nts (25%), and perisplenic disease in 15 patients (37.5%). The histopa thological diagnosis of the resected spleens showed microscopic hilar disease in four patients who had the spleen removed because of iatroge nic injury and no disease in only two patients. Splenectomy could be c arried out with an acceptable morbidity. Left-sided pleural effusion w as the most frequent complication. The estimated two-year survival rat e for patients who underwent splenectomy during primary surgery with n o residual disease and <2 cm intraperitoneal residual disease was 83% and 42%, respectively. Nine of these patients (64.3%) had recurrent di sease. The median time to recurrence was 11 months (range 5-18). The e stimated two-year survival rate for patients who underwent splenectomy during secondary surgery with no residual disease and <2 cm intraperi toneal residual disease was 78% and 24%, respectively. The estimated t hree-year survival rate was 0% for all these patients. The results of the present study show that splenectomy, if necessary to achieve optim al debulking, should be considered in previously untreated patients wi th no intraperitoneal residual disease and in patients with late (>1 y ear) recurrent disease.