Results of laparoscopic splenectomy for treatment of malignant conditions

Abstract

Laparoscopic splenectomy (LS) is widely accepted for treatment of benign diseases, but there are few reports of its use in cases of haematological malignancy. In addition, comparative studies with open operation are lacking. Malignant haematological diseases have specific clinical features-notably splenomegaly and impaired general health-which can impact on the immediate outcome after LS. The immediate outcome of LS comparing benign with malignant diagnoses has been analysed in a prospective series of 137 operations. Between February 1993 and April 2000, 137 patients with a wide range of splenic disorders received LS. Clinical data and immediate outcome were prospectively recorded,and age, diagnosis, operation time, perioperative transfusion requirement, spleen weight, conversion rate, accessory incision, hospital stay and complications were analysed. The series included 100 benign cases and 37 suspected malignancies. In patients with malignant diseases the mean age was greater (37 years [3-85] vs 60 years [27-82], p<0.01), LS took longer (138 min [60-400] vs 161 min [75-300], p<0.05) and an accessory incision for spleen retrieval was required more frequently (18% vs 93%, p<0.01) because the spleen was larger (279 g [60-1640] vs 1210 g [248-3100], p <0.01). However, the rate of conversion to open operation (5% vs 14%), postoperative morbidity rate (13% vs 22%) and transfusion requirement (15% vs 26%) did not differ between benign and malignant cases. Hospital stay was longer in malignant cases (3.7 days [2-14] vs 5 days [2-14], p<0.05). LS is a safe procedure in patients with malignant disease requiring splenectomy in spite of the longer operative time and the higher conversion rate.