• Timucin Taner, David M Nagorney, Ayalew Tefferi, Thomas M Habermann, William S Harmsen, Seth W Slettedahl, and John H Donohue.
• *Department of Surgery †Division of Hematology, Department of Internal Medicine ‡Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
• Ann. Surg.. 2013 Dec 1;258(6):1034-9.

ObjectiveTo evaluate long-term outcomes after splenectomy for massive splenomegaly in a series of 222 consecutive patients.BackgroundSplenectomy for massive splenomegaly (>1500 g) provides palliation but is associated with a high rate of perioperative complications in a population of patients with advanced hematological malignancies. Predictive factors for survival and whether the palliative goals are achieved in the long-term are not well defined.MethodsPatients with various hematological disorders who underwent splenectomy between 1998 and 2009 were followed until death or for at least 2 years. Linear and logistic regression analyses were used to ascertain the impact of demographical factors, diagnoses, and preoperative transfusion parameters on the postoperative survival.ResultsSplenectomy for massive splenomegaly was performed most commonly for non-Hodgkin lymphoma (48%) and myeloid metaplasia (31%). Mean ± standard deviation splenic weight was 2731 ± 1393 g (range, 1500-13,085 g). Average operating time was 115 minutes, with a range from 46 to 346 minutes. Thirty-day mortality was 1.8%, and the complication rate was 20%. The most common complications were hemorrhage (9%) and portal venous thrombosis (9.9%). Relief from pressure-related symptoms was achieved in 98.5%, and durable remission of anemia and thrombocytopenia persisted in half of the patients at 2 years. Sex, age, and intraoperative blood loss were not significantly associated with survival. Preoperative need for red blood cell and platelet transfusions were the most significant risk factors associated with decreased survival.ConclusionsSplenectomy for massive splenomegaly can be performed safely and offers durable palliation. Preoperative transfusion requirement is an indicator of hematological disease severity and predictor of decreased survival.

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