Iatrogenic splenectomy during nephrectomy for renal tumors

Jeffrey K. Wang, Matthew K. Tollefson, Simon P. Kim, Stephen A. Boorjian, Bradley C. Leibovich, Christine M. Lohse, John C. Cheville, R. Houston Thompson

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objectives: To evaluate risk factors associated with iatrogenic splenectomy during nephrectomy and to assess outcomes among patients undergoing nephrectomy for renal tumors. Methods: Of 4323 patients who underwent nephrectomy at Mayo Clinic between 1992 and 2008, 33 (0.8%) had an iatrogenic/unplanned splenectomy. In a case-control study design, controls without splenectomy were matched 1:3 based on age, sex, surgical date, side of the renal tumor, surgical approach and surgeon. Perioperative features and survival were evaluated using conditional logistic and Cox regression. Results: Among the 33 iatrogenic splenectomy patients, the majority (94%) underwent radical, open and left-sided nephrectomy. Primary tumor classification ≥T3 was the only clinicopathological risk factor significantly associated with splenectomy (odds ratio 3.4; P=0.02). Compared with controls, patients with an iatrogenic splenectomy were more likely to have longer operative time (205 vs 171min; P=0.02), higher estimated blood loss (1.3 vs 0.3L; P=0.001), longer length of stay (median 7 vs 5 days; P=0.03) and a higher likelihood for postoperative complications (odds ratio 5.3; P=0.002). With a median of 9.8years of follow up, splenectomy patients tended to have greater all-cause mortality (hazard ratio 1.6; P=0.07), although this difference approached statistical significance. Conclusions: Iatrogenic splenectomy is a rare complication during nephrectomy and is associated with locally advanced tumors (≥pT3). It also carries prognostic significance for adverse perioperative outcomes and possibly diminished survival, although this warrants further study.

Original languageEnglish (US)
Pages (from-to)896-902
Number of pages7
JournalInternational Journal of Urology
Volume20
Issue number9
DOIs
StatePublished - Sep 1 2013

Keywords

  • Iatrogenic splenectomy
  • Incidental splenectomy
  • Nephrectomy complications

ASJC Scopus subject areas

  • Urology

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