Splenectomy for Massive splenomegaly: Long-term results and risks for mortality

Timucin Taner, David M. Nagorney, Ayalew Tefferi, Thomas Matthew Habermann, William S. Harmsen, Seth W. Slettedahl, John H. Donohue

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE:: To evaluate long-term outcomes after splenectomy for massive splenomegaly in a series of 222 consecutive patients. BACKGROUND:: Splenectomy 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. METHODS:: Patients 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. RESULTS:: Splenectomy 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. CONCLUSIONS:: Splenectomy 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.

Original languageEnglish (US)
Pages (from-to)1034-1039
Number of pages6
JournalAnnals of Surgery
Volume258
Issue number6
DOIs
StatePublished - Dec 2013

Fingerprint

Splenomegaly
Splenectomy
Survival
Mortality
Erythrocyte Transfusion
Platelet Transfusion
Primary Myelofibrosis
Hematologic Diseases
Hematologic Neoplasms
Venous Thrombosis
Thrombocytopenia
Non-Hodgkin's Lymphoma
Anemia
Linear Models
Logistic Models
Regression Analysis
Hemorrhage
Pressure
Weights and Measures
Population

Keywords

  • lymphoma
  • myeloid metaplasia
  • splenectomy
  • splenomegaly

ASJC Scopus subject areas

  • Surgery

Cite this

Splenectomy for Massive splenomegaly : Long-term results and risks for mortality. / Taner, Timucin; Nagorney, David M.; Tefferi, Ayalew; Habermann, Thomas Matthew; Harmsen, William S.; Slettedahl, Seth W.; Donohue, John H.

In: Annals of Surgery, Vol. 258, No. 6, 12.2013, p. 1034-1039.

Research output: Contribution to journalArticle

Taner, Timucin ; Nagorney, David M. ; Tefferi, Ayalew ; Habermann, Thomas Matthew ; Harmsen, William S. ; Slettedahl, Seth W. ; Donohue, John H. / Splenectomy for Massive splenomegaly : Long-term results and risks for mortality. In: Annals of Surgery. 2013 ; Vol. 258, No. 6. pp. 1034-1039.
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abstract = "OBJECTIVE:: To evaluate long-term outcomes after splenectomy for massive splenomegaly in a series of 222 consecutive patients. BACKGROUND:: Splenectomy 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. METHODS:: Patients 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. RESULTS:: Splenectomy 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. CONCLUSIONS:: Splenectomy 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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T2 - Long-term results and risks for mortality

AU - Taner, Timucin

AU - Nagorney, David M.

AU - Tefferi, Ayalew

AU - Habermann, Thomas Matthew

AU - Harmsen, William S.

AU - Slettedahl, Seth W.

AU - Donohue, John H.

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N2 - OBJECTIVE:: To evaluate long-term outcomes after splenectomy for massive splenomegaly in a series of 222 consecutive patients. BACKGROUND:: Splenectomy 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. METHODS:: Patients 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. RESULTS:: Splenectomy 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. CONCLUSIONS:: Splenectomy 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.

AB - OBJECTIVE:: To evaluate long-term outcomes after splenectomy for massive splenomegaly in a series of 222 consecutive patients. BACKGROUND:: Splenectomy 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. METHODS:: Patients 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. RESULTS:: Splenectomy 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. CONCLUSIONS:: Splenectomy 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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KW - myeloid metaplasia

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