Value of splenectomy in non-Hodgkin's lymphoma.

Abstract

A retrospective review of patients with non-Hodgkin's lymphoma (NHL) who underwent palliative splenectomy for splenomegaly, hypersplenism, or autoimmune complications was done. From 1970 through 1981, 46 patients had palliative splenectomy for splenomegaly alone (n = 3) or various hematologic abnormalities with (n = 35) or without (n = 8) splenomegaly. Splenectomy was performed for life-threatening (n = 7), severe (n = 15), or mild (n = 24) symptoms/signs. The most common hematologic abnormalities were thrombocytopenia (platelet count less than 120,000/mm3; n = 38) and/or anemia (hemoglobin level less than 11.0 g/mm3; n = 29). Response to splenectomy was defined as greater than a threefold increase in preoperative platelet count and/or an increase in hemoglobin levels to greater than 11.0 g/mm3 in the first postoperative month. Four patients with thrombocytopenia did not respond, whereas 33 patients responded with greater than a sevenfold increase in platelet count. All four nonresponders died of complications of thrombocytopenia or progressive disease. Eighteen of 28 (64%) patients with anemia responded to splenectomy. Larger spleens (2000 g versus 1410 g; P less than 0.05) and lower platelet counts (42,000 versus 75,000; P less than 0.05) were found in all nonresponding patients. Responders and nonresponders could not be distinguished on the basis of age, sex, race, duration of disease or splenic involvement, primary site of disease, histopathologic findings, bone marrow or lymphangiogram results, or prior chemotherapy and radiotherapy. Patients with mild symptoms/signs were more likely to respond hematologically than patients with life-threatening or severe symptoms/signs (86% versus 54%; P = 0.06). For all patients, 2- and 5-year survival from the time of splenectomy was 44% and 26%, respectively. Median survival was 18 months (range, 1-144 months). Inability to reverse hematologic abnormalities was associated with poor survival. All nonresponding patients died within 36 months of surgery, whereas 5-year survival in responding patients was 40%. Nine of 30 patients (30%) who responded hematologically survived longer than 5 years, but this group of patients could not be distinguished from the remaining patients on the basis of age, sex, race, duration of disease or splenic involvement, primary site of disease, histopathologic features, bone marrow or lymphangiogram results, or prior chemotherapy and radiotherapy. Surgery was well-tolerated (mortality, 9%; morbidity, 21%). All surgical mortalities and 78% of complications occurred in patients operated on for life-threatening or severe symptoms/signs.(ABSTRACT TRUNCATED AT 400 WORDS)