Iatrogenic splenectomy during nephrectomy for renal tumors

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.