Results Of Splenectomy Research Articles

Splenectomy with endotherapy in non-cirrhotic portal fibrosis related portal hypertension: Can it be an alternative to proximal spleno-renal shunt?

Backgrounds/AimsProximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleeder NCPF patients.MethodsThe consecutive non-bleeder NCPF patients whom underwent either splenectomy or PSRS from 2008 to 2016 were enrolled. The patients were followed up post-surgery clinically and biochemical investigations, Doppler ultrasound and upper gastrointestinal endoscopy were done as required. The peri-operative parameters compared were operative time, blood loss, hospital stay and morbidity. The long-term outcome measures compared were incidence of portal hypertension (PHTN) related bleed, change in grade of varices, shunt patency, shunt complications and thrombosis of spleno-portal axis.ResultsAmong 40 patients with non-bleeder status, 24 underwent splenectomy and 16 underwent PSRS. The baseline characteristics including indication of surgery, biochemical investigations and grade of varices were comparable between PSRS and splenectomy. The peri-operative morbidity was not significantly different between two groups. The median follow up duration was 42 months (12-72 months), the decrement in grade of varices was significantly higher in PSRS group (p=0.03), symptomatic PHTN related UGIB was non-significant between PSRS and splenectomy (p=0.5). In PSRS group, 3 (18.3%) patients had shunt thrombosis (n=1) & encephalopathy (n=2) while in splenectomy group two patients developed thrombosis of splenoportal axis.ConclusionsSplenectomy with endotherapy is alternative to PSRS in non-bleeder NCPF patients with indications for surgery.

Long-term outcomes of oesophagogastric devascularization and splenectomy in patients with portal hypertension and liver cirrhosis.

Research about the long-term outcomes of oesophagogastric devascularization and splenectomy (OGDS) to treat portal hypertension (PH) is scarce. This study aimed to evaluate the safety and long-term treatment efficacy of OGDS, especially in elderly patients. During 2010-2016, open splenectomy and oesophagogastric devascularization (OSOD) and laparoscopic splenectomy and oesophagogastric devascularization were performed in 124 (group A) and 29 (group C) patients diagnosed with PH and liver cirrhosis, respectively. All patients aged less than 65 years. Besides, 39 patients aged 65 years or older undergoing open splenectomy and oesophagogastric devascularization were classified into group B. All clinical data were retrospectively analysed. Compared with group A, patients in group C had longer operative time, less blood loss and shorter post-operative hospitalization time. However, for perioperative data, there was no significant difference between group A and group B. During post-operative follow-up, compared with pre-operative condition, all haematology and liver function parameters significantly changed, except for alanine aminotransferase. For post-operative complications, only the portal vein system thrombosis rate was significantly higher in group C than group A. No significant difference was found in the overall survival rate among three groups, when non-variceal-rebleeding-related deaths were excluded. OGDS remains safe and effective to treat PH secondary to liver cirrhosis and it can be performed successfully in elderly patients and achieve a curative effect that is not inferior to young patients.

Splenik Marjinal Zon Lenfoma Tanılı Hastalarda Splenektomi ve İlaç Tedavisinin Sonuçları

Splenik Marjinal Zon Lenfoma Tanılı Hastalarda Splenektomi ve İlaç Tedavisinin Sonuçları

Impact of Platelet Counts, Surgical Methods, and Preoperative Platelet Transfusion on the Outcome of Splenectomy for Immune Thrombocytopenia

Introduction: Splenectomy is an important and potentially curative treatment for immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has replaced open splenectomy (OS) as the standard approach. The prognostic role of platelet count and the clinical indication of preoperative platelet transfusion are not entirely clear. Methods: We designed a study to explore the prognostic impact of surgical methods, platelet count, and platelet transfusion in a large, single-institute, long-term cohort of ITP patients. Result: In 118 ITP patients, there was no difference between OS and LS in response and surgical complications. The overall response rate was 77% and the complete response (CR) rate was 70%. Patients with a CR had a trend towards a higher baseline platelet count. A stable platelet count 14–28 days after splenectomy was associated with a sustained long-term response. Patients requiring preoperative platelet transfusion had a lower preoperative platelet count and were more likely to need postoperative transfusion of red blood cells and platelets. They also had a lower postoperative platelet count than the nontransfusion group. Relapse-free survival did not differ. Conclusions: Baseline and postoperative platelet counts are apparently associated with the treatment response to splenectomy but the difference did not reach statistical significance. Preoperative platelet transfusion did not overcome the disadvantage of thrombocytopenia and was not recommended when other preparative measures are available.

Autoimmune cytopenia in chronic lymphocytic leukemia: diagnosis and treatment.

Treatment response and survival of 83patients with CLL complicated by immune cytopenia (IC) were analyzed. Treatment schedules in 58medicated patients included corticosteroids; chemotherapy (COP, CHOP regimens), immunotherapy (rituximab alone), immunochemotherapy (rituximab-containing regimens- R-COP, R-CHOP). Twenty-five patients underwent splenectomy. The use of corticosteroids, as the first line of treatment, resulted in short-term remission in most patients. Chemotherapy was effective in a half of CLL patients, but duration of the remission did not exceed 32months in CLL associated with autoimmune hemolytic anemia and immune thrombocytopenia. After rituximab monotherapy (10patients) the stable remission was reached in 60% of the patients with median relapse-free survival of 40months. Rituximab containing chemotherapy (22patients) caused the long-term remission in 72% of the patients with median relapse-free survival of 76months. Splenectomy performed in 25patients with CLL complicated by IC was effective in 70% of the patients. The outcome of splenectomy depends on IC entity. The best response was registered in associated immune thrombocytopenia (median overall survival 118months), the worst- in Fisher- Evans syndrome (15months). The treatment of patients with CLL complicated by ICs should be individualized. For CLL patients without significant enlargement of lymph nodes and spleen, low lymphocytosis, associated with autoimmune hemolytic anemia or immune thrombocytopenia, the monotherapy with rituximab is optimal. In case of occurrence of autoimmune hemolytic anemia, immune thrombocytopenia or Fisher- Evans syndrome in CLL patients with enlargement of lymph nodes, spleen, significant lymphocytosis, the use of R-COP or R-CHOP schemes, 4-6courses, is the most effective. Splenectomy is indicated in patients with massive splenomegaly, the resistance to medication, recurrent relapses after adequate therapy.

Post total splenectomy outcome in thalassemia patients

Introduction: Splenectomy in thalassemia patient is indicated in the transfusion-dependent patient when hypersplenism increases blood transfusion requirement, prevents adequate control of body iron with chelation therapy and increased risk for infection.Method: This study was retrospective study aims to evaluate the outcome of splenectomy in pediatric thalassemia patients and its related factor. A total 34 thalassemia patient with post total splenectomy patients was included in this study.  Result: Mean age was 20.7 ± 6.5 years old with majority mild malnutrition (61.8%) and the majority of spleen size Schaffner 6-7 (73.5%). The duration between thalassemia diagnosis and total splenectomy was 6-7 years. Statistical analysis showed significant decreased of mean blood transfusion volume from 4691.4 cc per year to 3764.2 cc per year (p = 0.048), decreased mean blood transfusion volume from 219.6 cc per Kg Body Weight (BW) per year to 125.5 cc per Kg BW per year (p<0.001) and decreased of blood transfusion frequency from 12-14 times per year to 6-8 times per year (p<0.001). There is only one case subcutaneous emphysema as complication after splenectomy.Conclusion: Overall, this study showed total splenectomy improve the outcome of thalassemia with hypersplenism with low rate of complication.

Splenectomy in Lymphoproliferative Disorders: A Single Eastern European Center Experience.

Background and Objectives: Hematological malignancies are usually systemic diseases of life-threatening impact, and frequently require prompt and energetic therapeutic intervention. Due to systemic involvement, the role of surgery is generally limited to diagnostic approaches, and it is very rarely employed as a therapeutic modality. Splenectomy represents an exception to this paradigm, being used both as a diagnostic and tumor debulking procedure, notably in splenic lymphomas. Materials and Methods: We investigated the role of splenectomy in a single center prospective study of splenectomy outcome in patients with splenic involvement in the course of lymphoproliferative disorders. In the present study, we included all patients treated in our department for lymphoid malignancies over a period of six years, who underwent splenectomy as a diagnostic or debulking procedure after referral and workup, or had been referred to our department after first being splenectomized and diagnosed with splenic lymphoma. Patient characteristics and treatment outcome were investigated. Results: We enrolled 54 patients, with 34 (63%) splenectomized patients: 12 splenectomies (22.2%) for diagnostic purposes and 22 (40.7%) for treatment. Special attention was given to the 28 (51.85%) patients diagnosed with splenic marginal zone lymphoma (SMZL), a subtype with a clear therapeutic indication for splenectomy. Average age of patients was 57.5 (±13.1) years with a higher prevalence of feminine gender (66.67%). Age above 60 years old (p = 0.0295), ECOG (Eastern Cooperative Oncology Group) > 2 (p = 0.0402) and B-signs (p nonsignificant (NS)) were most frequently found in SMZL patients. Anemia, and notably autoimmune anemia, was more frequent in SMZL versus other small-cell lymphomas and also in splenectomized patients, as was leukocytosis and lymphocytosis. Treatment of patients with lymphoproliferative disorders consisted of chemotherapy and/or splenectomy. Most SMZL patients received chemotherapy as first line treatment (61.5%) and had only partial response (57.7%). Second treatment line was splenectomy in 80% of patients who required treatment, followed by a 60% rate of complete response (CR). Splenectomy offered a higher complete response rate (twice as high than in non-splenectomized, regardless of histology type, p = NS), followed by a survival advantage (Overall Survival (OS)~64 versus 59 months, p = NS). Particularly, SMZL patients had a 4.8 times higher rate of CR than other non-Hodgkin lymphoma (NHL) patients (p = 0.04), a longer progression free survival (73 months vs. 31 months for other small-cell NHLs p = NS) and a 1.5fold lower death rate (p = NS). The procedure was rather safe, with a 38.5% frequency of adverse reactions, mostly minor and manageable. Conclusions: Our data suggest that splenectomy is an effective and safe therapeutic option in patients with lymphoid malignancies and splenic involvement, particularly splenic marginal zone lymphoma.

A prospective study of postoperative outcome following splenectomy in immunocompromised thalassemia patient with special reference to CD4 count

Background: Thalassemia are inherited blood disorders that can result in the abnormal formation of hemoglobin. Splenectomy is indicated in the transfusion-dependent patient when hypersplenism increases blood transfusion requirement and prevents adequate control of body iron with chelation therapy. Ninety percent of recipients transfused with HIV antibody-positive blood are found to be HIV infected at follow-up. Prevailing literature on effects of splenectomy on CD4 count suggests that splenectomy causes an abrupt and prolonged increase in CD4 cell count. The aims and objectives this is an Institution based prospective observational study with the aim to observe postoperative outcome in immunocompromised thalassemic patients following splenectomy, postoperative outcome following splenectomy in a patient with low CD4 count and to analyze the effect of CD 4 count if any on different patients in terms of wound infection, chest infection , urinary tract infection or infection at any other site.Methods: The study included twenty immunocompromised thalassemia Patients attending in Pediatric Surgery OPD and admitted to Paediatric Surgery department of Medical college and hospital Kolkata with splenomegaly and HIV infection for splenectomy, between January 2015 to December 2016.Simple comparative analysis of gathered data was used to evaluate postoperative outcome m and the preop and the post op CD4 count levels of splenectomised thalassaemic patients.Results: Most patients in this study were in the (3-8) years age group and all are HIV positive patients with thalassemia. In this study author found there was increased CD4 count after splenectomy and postoperative period one patient developed postoperative oral candidiasis.Conclusions: HIV-infected thalassaemic patients on ART can now safely undergo major splenectomy surgery with encouraging results and in patients with a low CD4 count, there is no relation of CD4 count and splenectomy outcome.

Emergency or urgent splenectomy in children for non-traumatic reasons.

Emergency splenectomy is rarely performed since a widespread consensus exists towards conservative management of splenic injury. However, in selected conditions, mainly hematological, there is a role for emergency or urgent splenectomy. This study aims to retrospectively review these cases and discuss outcome in relation to the pre-existing splenic pathologies. Between 2000 and 2015, 12 patients, five girls, and seven boys, with a median age of sixyears (3months-13.11years), underwent emergency or urgent splenectomy for non-traumatic conditions. All patients had major associated disorders; mainly hematological (11 cases) including hemolytic anemia with pancytopenia (1), sickle cell anemia (1), AML (1), ALL (2), CML (1), T cell lymphoma (1), Burkitt lymphoma (1), and ITP (3). One patient had a microvillous inclusion disease. Indications for splenectomy included diffuse resistant splenic abscesses (4), intracranial hemorrhage (4) or hypersplenism (3) with refractory thrombocytopenia, and spontaneous splenic rapture (1). Nine patients improved following surgery but three died, owing to massive intracranial hemorrhage (1) and severe respiratory failure (2) despite aggressive management.Conclusions: Rarely, an emergency splenectomy is required in complex settings, mostly refractory hematological conditions, in a deteriorating patient when all other measurements have failed. A multidisciplinary team approach is mandatory in the treatment of these complex cases. What is known • Conservative treatment is advised for splenic injury. • Many hematological disorders are responsible of splenic pathology. What is new • Emergency splenectomy in children for reasons other than trauma is a treatment of last resort that should be performed in a multidisciplinary context. • The outcome of emergency splenectomy in children for reasons other than trauma depends on the underlying medical condition.

Systematic review and meta-analysis of splenectomy in gastrectomy for gastric carcinoma.

The role of splenectomy for patients with gastric cancer still remains controversial. We performed this meta-analysis to evaluate the safety and long-term oncological outcomes of splenectomy for patients with gastric cancer. A systematic literature search was performed using PubMed, EMBASE, Cochrane Library, and Web of Science from January 1997 to October 2018. The results were analyzed according to predefined criteria. All statistical analyses were performed using RevMan 5.3 software. In total, 16 studies with 4457 patients, including 3 randomized controlled trials (RCTs) and 13 non-randomized controlled trials (nRCTs), were analyzed. The meta-analysis showed the splenectomy group was associated with higher rates of overall postoperative complication, anastomosis leakage, abdominal abscess, and pancreatic fistula. Regarding long-term oncological outcomes, the splenectomy group showed lower 5-year overall survival (OS) and higher recurrence rates on subgroup analysis for the nRCTs. No significant difference was observed in the 5-year OS and recurrence rates between the two groups on subgroup analysis for the RCTs. Splenectomy increases postoperative complications without clearly improving long-term prognosis.

Indications and Outcomes of Splenectomy for Hematological Disorders.

Background and AimSplenectomy is a frequent component of the diagnosis and treatment of hematological disorders. The aim of this study was to define the indications and outcomes of splenectomy for benign and malign hematological disorders.Materials and MethodsOne hundred and two patients with hematological disease who had splenectomy at Hacettepe University Hospital between the years of 2010 and 2018 were evaluated.ResultsA total of one hundred and two patients were included in this study. The median age was 52 (20-82) years at the time of splenectomy. Most of the patients were female (57.9%). The median follow up time was 11.0 (0.03-87.9) months after splenectomy. Splenectomy was performed to diagnose thirty patients (29.4%). Seventy-two patients underwent splenectomy for the treatment of hematological disease (70.6%). Twenty-seven patients (90%) were diagnosed with various lymphomas. Two patients (6.7%) were diagnosed with hairy cell leukemia and one patient (3.3%) was diagnosed with large granular lymphocytic leukemia.ConclusionIn conclusion, an improvement in medical therapy, especially with monoclonal antibodies, the indications and outcomes of splenectomy for hematologic disorders have changed extremely in last years. Nevertheless, splenectomy has an important role for diagnosis and treatment of benign and malign hematological disorders.

PF714 PATIENT PERCEPTIONS ON SPLENECTOMY OUTCOMES: RESULTS FROM THE ITP WORLD IMPACT SURVEY (I‐WISH)

Background:Splenectomy is highly effective in 60–70% of patients (pts) with immune thrombocytopenia (ITP). However, as with other treatments, there are no consistent clinical predictors for success or potential complications. Second‐line treatment decisions, including splenectomy, have become more complicated with more options. More information on pts perceptions on splenectomy is needed.Aims:I‐WISh studied the burden of ITP and its impact on quality of life (QoL). Here, we report pts perceptions on splenectomy outcomes.Methods:I‐WISh is a cross‐sectional survey of 1507 ITP pts and 472 physicians across 13 countries; pts were recruited via physicians and patient advocacy groups (PAGs). Pts and physicians completed a 30‐min online survey that included demographics, signs and symptoms, impact of symptoms, and pt–physician relationships. A steering committee of expert physicians and PAG ITP specialists designed and endorsed the survey materials.Results:The physicians mean (SD) no. of ITP pts was 34 (50) with a mean (SD) of 18 (36) newly diagnosed pts in the past year. Physicians recommended splenectomy in 32% of pts with persistent, chronic, recurrent ITP. On average, 17% of pts (total n = 263; PAG, n = 197; physician invited, n = 66) underwent splenectomy. The pts mean age was 51 years and 46 years for those who did or did not undergo splenectomy, respectively. Pt‐perceived consequences across all countries were: regular immunizations (54%), increased infections (29%), carrying splenectomy card for travel (24%), pancreatic/stomach inflammation (16%), daily need for antibiotics (14%), frequent respiratory symptoms (12%), thrombosis (10%), sepsis/fever requiring ER visits (9%), and other (9%). One or more of these consequences was experienced by 78% of pts. Significant inter‐country variations were observed. In those who had received splenectomy, pts rated how much they agree with the statements of impact on their QoL, ie, scored ≥5 on a 7‐point Likert scale where 7 = strongly agree. Symptoms that pts were most interested to resolve included fatigue (48%) and anxiety surrounding unstable platelet count (26%). Overall satisfaction with the splenectomy outcomes was perceived by 38% of pts, although 15% of pts felt it was an undesirable treatment even though it worked. Splenectomy had been effective in treating the ITP symptoms in 36% of pts. However, 43% of pts regretted having undergone splenectomy because it did not work. For 25% of pts, splenectomy had caused other problems and they regretted having it. Amongst all responders, immunosuppressive effect was the top concern (60%), with 30% of pts being worried about the need for regular immunizations. Only 54% of pts felt they were made aware of the long‐term complications of splenectomy before surgery, and 56% of pts were worried about long‐term side effects. Concern about short‐term side effects, taking oral antibiotics after splenectomy, risk of septicemia, and risk of blood clots were raised by 32%, 23%, 37% and 32% of pts, respectively (Fig).Summary/Conclusion:Results highlighted the need for improved pt education on the potential adverse effects of splenectomy although there are limitations to this survey. Pts could have undergone splenectomy at any time prior to the survey explaining lack of awareness of long‐term complications. Pts in whom splenectomy was not successful or those who had post‐operative complications were more likely to continue to see their physician and/or be involved with PAGs (3/4 of responders to survey) and therefore participate in the survey than long‐term responders.image

Outcomes of splenectomy in relapsed/refractory autoimmune hemolytic anemia

目的评估脾切术治疗复发/难治自身免疫性溶血性贫血（AIHA）患者的疗效。方法回顾性分析中国医学科学院血液病医院30例行脾切除术治疗的复发/难治自身免疫性溶血性贫血（AIHA）患者的临床资料，评估手术疗效。结果30例复发/难治AIHA患者中，单纯AIHA 20例（温抗体型13例，温冷双抗体型2例，Coombs阴性AIHA 5例），Evans综合征10例。脾切除术后10~14 d，20例患者可评价疗效，总有效率（ORR）为90%（完全缓解12例，部分缓解6例）。13例患者有长期随访资料，中位随访14（4~156）个月，截至随访终点，除3例Evans综合征患者死亡外（2例无效，1例复发），10例复发/难治AIHA患者术后6个月9例（90%）有效，术后12个月7例（70%）有效，其中3例患者已持续完全缓解3年以上。结论脾切除术作为二线方案治疗复发/难治AIHA近期疗效好，1年远期ORR达到70%，约三分之一患者可维持长期持续缓解。

Is ITP really a desirable indication for teaching laparoscopic splenectomy? Cohort study

Background: We aimed to evaluate the outcomes of laparoscopic splenectomy (LS) in patients with immune thrombocytopenic purpura (ITP) compared with operated for other indications.Methods: Retrospective cohort study of patients who underwent LS in 1998–2017. Group 1 consisted of 256 patients operated for ITP, and Group 2 of 231 operated for other indications. Primary outcome was procedure difficulty. Secondary was perioperative course (30 days of surgery).Results: Patients in Group 1 were younger (p < .001) with lower ASA (p < .001). The spleen was larger in Group 2 (p < .001). Operative time was longer in Group 2 [110 (80–150) vs. 90 (65–115) min; p < .001)]. Intraoperative blood loss was greater in Group 2 (p < .001). Conversions were higher in Group 2 (4.76 vs. 6.93%, p = .037), as were intraoperative complications (7.79 vs. 3.91%, p = .048). Morbidity, reoperations and mortality did not differ between groups (respectively, p = .899, .697, and .999). Median length of stay was similar (p = .211). Among the first 10 LSs performed by trainees, 63.66% were done for ITP. Later (after 11+ procedures) this dropped to 48.12% (p = .002).Conclusions: ITP may be a preferred indication for surgeons training for LS. Patients’ characteristics and intraoperative factors allow an expectation for a relatively easy and hassle-free operation in those patients.

The effect of splenic hilum ligation on the injured spleen and its function in rat model

Background: The aim of this study was to compare the outcome of splenic hilum ligation (SHL) and splenectomy in spleen trauma in rat model. Methods: This interventional study was performed on 38 rats with spleen injuries. Rats were randomly divided into SHL and splenectomy groups. After 7 days of surgery, IgG, IgA, IgM, and IgE were measured. At this time, blood smear was prepared to evaluate Howell–Jolly bodies, target cells, schistocyte, poikilocyte, and anisocyte. Three months after the surgery, the spleen viability was evaluated by relaparotomy. Results: After 7 days, white blood count was significantly lower in SHL group as compared to control group (P = 0.024). All variables in peripheral blood smear were significantly lower in SHL group as compared to control group, except Howell–Jolly bodies (P = 0.461). In the SHL group, all spleens were viable in second operations. Conclusions: SHL can be used safely in the management of traumatic splenic injuries in rats.

Long Term Outcome Following Splenectomy in Children

Aim: The aim of the study is to evaluate the efficacy, complications and long term results of splenectomy in children with hematologic diseases.Patients and Methods: This study includes retrospective analysis of the medical records of 158 children between 0-18 years old who underwent splenectomy due to hematologic diseases from 1989 to 2017. Gender, splenectomy indications, age of diagnosis, splenectomy age, vaccination status, splenectomy outcomes, complications and mortality were evaluated.Results: Of the cases, 88 (55.7%) were female and 70 were male (44.3%). Indications for splenectomy were hereditary spherocytosis in 59 (37.3%), immune thrombocytopenia (ITP) in 50 (31.6%) and thalassemia major in 40 (25.3%) children. The median age of diagnosis was 3.9 years, the median splenectomy age was 9.2 years, the median time from diagnosis to splenectomy was 5.3 years in all cohort. Mean follow-up time of patients after splenectomy was 7.3±5.2 years. All patients except one were immunized before splenectomy. Responses were assessed based on standart criteria for each disease. Response was seen in 94.7% of patients with hereditary spherocytosis and 80% of ITP patients. Twenty-two percent of splenectomised children with thalassemia major had a decrease in transfusion frequency. Infections following splenectomy were reported in 22.8%. One patient had thrombosis related to splenectomy, none of the cases had major bleeding. There was no death due to sepsis. One patient with ITP died due to Subacute Sclerosing Panencephilitis (SSPE).Conclusion: Splecetomy is associated with good remission rates following ITP and hereditary spherocytosis. Splenectomy should be performed only in selected cases with transfusion dependent thalassemia. Post-splenectomy sepsis is uncommon. Future studies should focus on health quality of life and cost analysis of splenectomy in children. DisclosuresNo relevant conflicts of interest to declare.

Is concomitant splenectomy necessary in radical gastric cancer surgery? A systematic review and meta-analysis.

This study is a systematic review and meta-analysis compare the short- and long-term outcomes of splenectomy (SP) versus splenic preservation (NSP) in radical gastric cancer surgery. A comprehensive search of PubMed, Embase, Cochrane Library and Web of Knowledge was performed. Evaluation of short- and long-term outcomes was collected and analyzed by a fixed or random effects model, according to the heterogeneity using RevMan 5.2 software. A total of 5431 gastric cancer patients who underwent radical surgery (1706 with SP and 3725 with NSP) were reviewed in 11 studies included in this study. Compared with NSP, SP was significantly associated with higher rate of overall postoperative complication and increased incidence of pulmonary complications, abdominal abscess and pancreas complications. No statistical difference was observed regarding mortality, wound infection, anastomotic leakage and postoperative 5-year overall survival. There was no difference in long-term oncological outcome but remarkably poorer short-term outcomes in SP group than NSP group. Therefore, SP seems unnecessary in radical gastric cancer surgery. However, well-designed, multicenter, prospective, randomized controlled trials are warranted for further validation.

Laparoscopic splenectomy for immune thrombocytopenia (ITP): long-term outcomes of a modern cohort.

The advent of newer second-line medical therapies (SLMT) for immune thrombocytopenia (ITP) has contributed to decreased rates of splenectomy, following a trend to avoid or delay surgery. We aimed to characterize the long-term outcomes of laparoscopic splenectomy (LS) for ITP at our institution, examining differences in LS efficiency when performed before or after SLMTs. Adults with primary ITP who underwent LS between 2002 and 2016 were identified. Retrospective review of electronic medical records was supplemented with telephone interviews. Treatment response was defined according to current guidelines as complete responders (CR), responders (R), and non-responders (NR). Kaplan-Meier estimates assessed relapse-free rates, and predictors of long-term response were investigated using logistic regression. 109 patients met inclusion criteria, from which 42% were treated with an SLMT before referral to LS. LS was completed in all cases, with no conversions or intraoperative complications. The perioperative morbidity was 7.3%, including 3 deep vein and 2 portal vein thrombosis, one reoperation for bleeding, and no mortalities. Splenectomy was initially effective in 99 patients (CR + R = 90.8%), and 10 patients were NR. At a median 62-month follow-up, 25 patients relapsed, resulting in a 68% CR + R rate. Proportion of CR + R was similar in patients who previously received SLMT and those who did not (61 vs. 76.7%, p = 0.08). CR + R patients were younger (45 vs. 53, p = 0.03), had higher preoperative platelet counts (36 vs. 19, p = 0.01), and experienced a higher increment in platelet counts during hospital stay (117 vs. 38, p < 0.001) as well as 30-days postoperatively (329 vs. 124, p < 0.001). Only a robust response in platelet count at 30-days postoperatively was independently associated with long-term response (OR 1.005, p = 0.006). LS was curative in 68% of patients, with no statistically significant difference when performed before or after SLMTs. Outcomes remain challenging to predict preoperatively, with only a robust increase in platelet counts on short term being associated with long-term response.

Autologous 111In‐labelled platelet scan as a predictor of splenectomy outcome in ITP

Autologous ¹¹¹In‐labelled platelet scan as a predictor of splenectomy outcome in <scp>ITP</scp>

3:54 PM Abstract No. 19 Implementation of the EAST guidelines for splenic trauma: comparing outcomes of splenic artery embolization and splenectomy at a large level 1 trauma center

3:54 PM Abstract No. 19 Implementation of the EAST guidelines for splenic trauma: comparing outcomes of splenic artery embolization and splenectomy at a large level 1 trauma center