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Splenectomy in Patients with Splenomegaly in the Setting of Myeloid Neoplasm: A Single Institution Experience
*Vijaya T Daniel¹, *Bankole Samuel¹, *Kofi Atiemo¹, *Muthalagu Ramanathan², *Rajneesh Nath², *Sonia N. Chimienti³, *Richard A. Perugini¹, *Jan Cerny^4
1Department of Surgery, University of Massachusetts Medical School, Worcester, MA;²Division of Hematology Oncology, Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA;³Division of Infectious Diseases , Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA;⁴University of Massachusetts, Worcester, MA

Objectives: Splenomegaly in the setting of myelodysplasia (MDS), myeloproliferative neoplasm (MPN), or secondary myelofibrosis (MF) is common and is the result of extramedullary hematopoiesis and expansion of malignant cells. Although stem cell transplant (SCT) can be an effective therapy, the role of splenectomy in conjunction with SCT to minimize adverse symptoms associated with splenomegaly is currently unclear given the high mortality associated with splenectomy. Our aim was to evaluate perioperative complications and long term survival among patients who underwent a laparoscopic splenectomy in the context of SCT.
Design: Series of patients from one institution with MDS, MPN, or MF who underwent laparoscopic splenectomy in the context of SCT
Setting: Large, teaching hospital in a metropolitan setting (2009-2014)
Patients: The series included 6 patients who were predominantly male (5/6), with a median age of 69 years (range 34-74). Four had thrombocytopenia, and one with autoimmune hemolytic anemia.
Intervention: Laparoscopic splenectomy
Main Outcome Measures: 1º: Mortality; 2º Perioperative blood transfusion, Length of Stay, Postoperative 30-day complications
Results: Overall, 6 patients underwent laparoscopic splenectomies. The median spleen size was 855 g (range 300-1470g). Five of six patients had postoperative complications including deep venous thrombosis, thrombosis of carotid stent, superficial wound infection, colitis, or pneumonia. Hospital length of stay ranged from 5-40 days. Within 15 days, one patient died from respiratory failure due to leukagglutination syndrome. By one year follow-up, two patients had died from infectious complications. 50% of patients remain alive now (range 975-2101 days).
Conclusions: Splenectomy is associated with infectious and thrombotic complications, and hemorrhage is surprisingly avoidable. Although perioperative mortality is high, longer term survival of these patients with splenectomy in conjunction with SCT is possible.

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