Splenectomy as part of cytoreductive surgery in ovarian cancer

Paul Magtibay, Peter B. Adams, M. Bradley Silverman, Stephen S. Cha, Karl C. Podratz

Research output: Contribution to journalReview article

72 Citations (Scopus)

Abstract

Objective.: Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.: Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.: Of 112 patients, 66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%), formal lymphadenectomy (31%), or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%), facilitation of an en bloc resection of perisplenic disease (41%), and intraoperative trauma (13%). Histologically, 65% had hilar involvement; 52%, capsular involvement; and 16%, parenchymal metastases. Short-term complications included wound infections (7), pneumonias (5), thromboembolic events (9), and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient, with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess), and with no identifiable infectious source in 2. Two patients required reoperation for bleeding: 1 for diffuse intraabdominal bleeding, including the splenic bed, and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%: 3 from sepsis (1 anastomotic leak, 2 pneumonias), 2 from pulmonary embolism, and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years, with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years, with an estimated 2-year survival of 42%. Conclusions.: In patients with clinically significant upper abdominal disease, splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.

Original languageEnglish (US)
Pages (from-to)369-374
Number of pages6
JournalGynecologic oncology
Volume102
Issue number2
DOIs
StatePublished - Aug 1 2006

Fingerprint

Splenectomy
Ovarian Neoplasms
Sepsis
Pneumonia
Anastomotic Leak
Hemorrhage
Survival
Carcinoma
Mortality
Mycoses
Wound Infection
Lymph Node Excision
Urinary Tract
Pulmonary Embolism
Reoperation
Abscess
Cause of Death
Neoplasms
Survival Rate
Odds Ratio

Keywords

  • Ovarian carcinoma
  • Splenectomy
  • Surgical cytoreduction

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Magtibay, P., Adams, P. B., Silverman, M. B., Cha, S. S., & Podratz, K. C. (2006). Splenectomy as part of cytoreductive surgery in ovarian cancer. Gynecologic oncology, 102(2), 369-374. https://doi.org/10.1016/j.ygyno.2006.03.028

Splenectomy as part of cytoreductive surgery in ovarian cancer. / Magtibay, Paul; Adams, Peter B.; Silverman, M. Bradley; Cha, Stephen S.; Podratz, Karl C.

In: Gynecologic oncology, Vol. 102, No. 2, 01.08.2006, p. 369-374.

Research output: Contribution to journalReview article

Magtibay, P, Adams, PB, Silverman, MB, Cha, SS & Podratz, KC 2006, 'Splenectomy as part of cytoreductive surgery in ovarian cancer', Gynecologic oncology, vol. 102, no. 2, pp. 369-374. https://doi.org/10.1016/j.ygyno.2006.03.028
Magtibay, Paul ; Adams, Peter B. ; Silverman, M. Bradley ; Cha, Stephen S. ; Podratz, Karl C. / Splenectomy as part of cytoreductive surgery in ovarian cancer. In: Gynecologic oncology. 2006 ; Vol. 102, No. 2. pp. 369-374.
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abstract = "Objective.: Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.: Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.: Of 112 patients, 66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50{\%}), formal lymphadenectomy (31{\%}), or urinary tract resection (5{\%}). The most common indications for splenectomy were direct metastatic involvement (46{\%}), facilitation of an en bloc resection of perisplenic disease (41{\%}), and intraoperative trauma (13{\%}). Histologically, 65{\%} had hilar involvement; 52{\%}, capsular involvement; and 16{\%}, parenchymal metastases. Short-term complications included wound infections (7), pneumonias (5), thromboembolic events (9), and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient, with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess), and with no identifiable infectious source in 2. Two patients required reoperation for bleeding: 1 for diffuse intraabdominal bleeding, including the splenic bed, and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5{\%}: 3 from sepsis (1 anastomotic leak, 2 pneumonias), 2 from pulmonary embolism, and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years, with an estimated 2-year survival rate of 46{\%}. The median survival in the secondary debulking group was 1.7 years, with an estimated 2-year survival of 42{\%}. Conclusions.: In patients with clinically significant upper abdominal disease, splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.",
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AU - Magtibay, Paul

AU - Adams, Peter B.

AU - Silverman, M. Bradley

AU - Cha, Stephen S.

AU - Podratz, Karl C.

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N2 - Objective.: Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.: Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.: Of 112 patients, 66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%), formal lymphadenectomy (31%), or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%), facilitation of an en bloc resection of perisplenic disease (41%), and intraoperative trauma (13%). Histologically, 65% had hilar involvement; 52%, capsular involvement; and 16%, parenchymal metastases. Short-term complications included wound infections (7), pneumonias (5), thromboembolic events (9), and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient, with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess), and with no identifiable infectious source in 2. Two patients required reoperation for bleeding: 1 for diffuse intraabdominal bleeding, including the splenic bed, and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%: 3 from sepsis (1 anastomotic leak, 2 pneumonias), 2 from pulmonary embolism, and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years, with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years, with an estimated 2-year survival of 42%. Conclusions.: In patients with clinically significant upper abdominal disease, splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.

AB - Objective.: Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma. Methods.: Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery. Results.: Of 112 patients, 66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%), formal lymphadenectomy (31%), or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%), facilitation of an en bloc resection of perisplenic disease (41%), and intraoperative trauma (13%). Histologically, 65% had hilar involvement; 52%, capsular involvement; and 16%, parenchymal metastases. Short-term complications included wound infections (7), pneumonias (5), thromboembolic events (9), and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient, with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess), and with no identifiable infectious source in 2. Two patients required reoperation for bleeding: 1 for diffuse intraabdominal bleeding, including the splenic bed, and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%: 3 from sepsis (1 anastomotic leak, 2 pneumonias), 2 from pulmonary embolism, and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years, with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years, with an estimated 2-year survival of 42%. Conclusions.: In patients with clinically significant upper abdominal disease, splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.

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